The prevalence and risk factors associated with esophageal varices in subjects with hepatitis C and advanced fibrosis

Gastrointest Endosc. 2006 Dec;64(6):855-64. doi: 10.1016/j.gie.2006.03.007.

Abstract

Background: The factors predictive of the presence or the absence of esophageal varices in hepatitis C virus (HCV) and advanced fibrosis have not been defined.

Objectives: To define the prevalence of esophageal varices and the factors that are positively and negatively with such varices in hepatitis C and advanced fibrosis.

Design: A prospective study of esophageal varices and associated risk factors in subjects with hepatitis C and advanced fibrosis.

Setting: Prerandomization data from the HALT-C (hepatitis C long-term antiviral treatment against cirrhosis) clinical trial.

Patients and intervention: Subjects with bridging fibrosis or cirrhosis, who were virologic nonresponders to treatment with pegylated interferon alpha 2a and ribavirin, underwent endoscopy.

Results: Sixteen percent of subjects with bridging fibrosis (95/598) and 39% of subjects with cirrhosis (164/418) had varices (P < .0001); 2% of subjects with bridging fibrosis (13/598) and 11% of those with cirrhosis (48/418) had medium or large varices. Subjects with bridging fibrosis and varices had a significantly lower platelet count and higher bilirubin and international normalized ratio (INR) compared with those without varices, suggesting that the biopsy may have underestimated the severity of fibrosis. A platelet count >150,000/mm(3) was associated with a negative predictive value of 99% for esophageal varices. By logistic regression modeling, African American race and female sex were protective, whereas a lower platelet count and higher bilirubin and INR predicted varices (c statistic, 0.758).

Conclusions: The risk of having varices increases with decreasing platelet counts, increasing bilirubin, and INR. The probability of having medium or large varices at platelet counts >150,000/mm(3) is negligible in this population.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antiviral Agents / therapeutic use
  • Biopsy
  • Disease Progression
  • Endoscopy, Gastrointestinal
  • Esophageal and Gastric Varices / diagnosis
  • Esophageal and Gastric Varices / epidemiology*
  • Esophageal and Gastric Varices / etiology
  • Female
  • Follow-Up Studies
  • Hepatitis C, Chronic / complications*
  • Hepatitis C, Chronic / diagnosis
  • Hepatitis C, Chronic / drug therapy
  • Humans
  • Liver / pathology
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / diagnosis
  • Liver Cirrhosis / prevention & control
  • Male
  • Middle Aged
  • Platelet Count
  • Prevalence
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Time Factors

Substances

  • Antiviral Agents