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Prognostic Indicators of Risk for First Variceal Bleeding in Cirrhosis: A Multicenter Study in 711 Patients To Validate and Improve The North Italian Endoscopic Club (Niec) Index
- Source :
- American Journal of Gastroenterology, 95(10), 2915-2920. Springer Nature
- Publication Year :
- 2000
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2000.
-
Abstract
- The best known indicator of risk for first bleeding in patients with cirrhosis without previous bleeding is the index devised by the North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices (NIEC index), which results from the combination of size of esophageal varices, severity of red wale marks, and Child-Pugh class. Its efficiency is far from optimal, and validation studies have reported sensitivities and specificities markedly lower than those reported in the original study. In the present study we analyzed the efficiency of NIEC index in a large series of cirrhotic patients with varices without previous bleeding. In addition, we tried to improve the effectiveness of the index by modifying it, and to validate the modifications in an independent group of patients.A total of 627 patients were enrolled and followed until either a variceal bleeding or for a maximum of 2 yr. During this time, 117 experienced a first varicealUsing Cox's regression analysis, size of varices, severity of red wale marks, and Child-Pugh score were significant and independent predictors of first bleeding, as already noted in the original report of the NIEC group. However, coefficients and standard errors were markedly different, and the importance of size of esophageal varices in the regression was much larger, whereas that of Child-Pugh score was much lower. According to these data, a revised index was developed (Rev-NIEC). Using receiver operating characteristic (ROC) curve analysis, the revised index showed a larger efficiency, and the area under the curve was significantly larger (0.80 +/- 0.02 vs 0.74 +/- 0.02; p0.01). In particular, the curve showed that for a specificity of 75%, the new index had a sensitivity of 72% compared to that of 55% of the NIEC index. Validation in an independent sample of 84 patients showed good agreement between predicted and observed risk for bleeding. Validation with the bootstrap technique also showed adequate stability of the results.The revised index seems to be superior to the traditional index, and may turn out to be more useful in the selection of patients for different therapeutic procedures and in the stratification of patients in clinical trials.
- Subjects :
- Liver Cirrhosis
Male
medicine.medical_specialty
Cirrhosis
Esophageal and Gastric Varices
Gastroenterology
Angiodysplasia
Liver Function Tests
Risk Factors
Internal medicine
Gastroscopy
medicine
Humans
Risk factor
Laparoscopy
Aged
Varix
Hepatology
medicine.diagnostic_test
business.industry
General surgery
Middle Aged
Prognosis
medicine.disease
Endoscopy
Italy
ROC Curve
Female
Club
Gastrointestinal Hemorrhage
Varices
business
Liver function tests
Subjects
Details
- ISSN :
- 00029270
- Volume :
- 95
- Database :
- OpenAIRE
- Journal :
- American Journal of Gastroenterology
- Accession number :
- edsair.doi.dedup.....f8342e618d7836ea90a773f3738f692a
- Full Text :
- https://doi.org/10.1111/j.1572-0241.2000.03204.x