A novel scoring system for prediction of esophageal varices in critically ill patients

Figures & data

Table

Blood urea, mg%
<39	0
39–48	2
49–59	3
60–149	4
>150	6
Hb for men (g/dL)
≥13	0
12–12.9	1
10–11.9	3
<10	6
Hb for women (g/dL)
≥12	0
10–11.9	1
<10	6
Systolic blood pressure (mmHg)
≥110	0
100–109	1
90–99	2
<90	3
Other markers
Pulse >100 (b/min)	1
Melena	1
Syncope	2
Hepatic	2
Cardiac	2
Renal	2

Abbreviation: Hb, hemoglobin.

Table 2 OV metric score for noninvasive prediction of esophageal varices

Points	0	1	2	3
Clinicolaboratory criteria
1-Splenomegaly by palpation	Absent	Present
2-Child Pugh score	Score <7		Score >7
3- AST/ALT ratio	<1	>1
4- Platelet count	>150×10^3/uL	100–150×10^3/uL	80–100×10^3/uL	<80×10^3/uL
Ultrasonographic criteria
1-PVD (mm)	<13	13–15	>15
2-SBD (cm)	<13	13–18	>18
3-SVD (mm)	<10	10–12	12 mm with hilar varices
Doppler criteria
1-PVCi (cm×sec)	<0.07	0.07–0.14	>0.14
2-RARI	<0.68	0.68–0.7	>0.7

Abbreviations: ALT, alanine transaminase; AST, aspartate transaminase; PVD, portal vein diameter; SBD, splenic bipolar diameter; SVD, splenic vein diameter; PVCi, portal vein congestive index; RARI, renal artery resistive index; OV, esophageal varices.

Figure 1 Abdominal ultrasonography of young adult pregnant female presenting with hematemesis showed cirrhotic liver with moderate ascites and intrauterine pregnancy.

Figure 2 Colour Doppler sonography of the portal vein with maximum flow velocity of 12.7 cm/s, minimum flow velocity of 9.2 cm/s, and mean flow velocity of 11 cm/s. Portal vein cross-sectional area equals 20.4 mm.

Figure 3 Doppler sonography of the right kidney showing increased renal arteriolar resistive index with a value of 0.71.

Table 3 Baseline clinical, laboratory, ultrasonographic, and Doppler criteria of the patients under study stratified by their GBS value

Data (criteria)	GBS 0 (N=6)	GBS <2 (N=30)	GBS 3–6 (N=48)	GBS >6 (N=216)	P-value
Age (years)	44.3±16.3	50.6±11.5	53.1±14.2	54.4±11.3	0.4
M/F	0/6	18/12	36/12	138/78	0.08
Systolic (mmHg)	120.2±3.2	110±12.2	100.8±2.5	86.5±7.8	0.008
Pulse (b/min)	78.4±4.8	84.8±4.3	95.4±11.1	101.2±20.8	0.005
Hb (gm/dL)	12.2±0.4	11.7±0.62	9.9±2.9	7.6±1.5	0.000
Platelets (103/µL)	148±7.2	168.2±18.1	192.5±56.7	107.6±50.8	0.000
INR	1.1±0.1	1.02±0.04	1.9±0.78	1.62±0.7	0.04
Albumin (gm/dL)	3.5±0.4	3.9±0.26	3.85±0.28	2.8±0.7	0.03
Total bilirubin (mg/dL)	0.75±0.2	0.93±0.06	1.07±0.17	1.58±0.58	0.04
AST(IU/L)	37±0.2	37.2±7.1	42.2±8.1	61.2±24.5	0.02
ALT(IU/L)	33±0.3	34.8±3.5	40.8±7.5	55.6±19	0.058
Creatinine (mg/dL)	0.9±0.2	0.91±0.1	1.12±0.36	2.02±0.85	0.02
Urea (mg/dL)	30.1±0.23	28±6	33±6.2	61.3±21.7	0.03
Melena	0	0	18	192	0.001
Pre-syncope	0	0	0	104	0.001
GBS	0	1	4.13±1.3	15.1±3.9	0.002
PVD	11±0	10.2±0.54	10.2±0.6	13.3±2.2	0.02
SBD	11±0	10.5±5.1	11.5±8.4	15.1±3.5	0.03
SVD	6±0	5.9±0.46	5.8±0.6	9.5±2.6	0.01
PVCi	0.08±0	0.07±0.01	0.069±0.01	0.134±0.05	0.03
RARI	0.6±0	0.57±0.1	0.58±0.03	0.74±0.12	0.04
OV score	3± 0	2.5±0.7	3 ± 0.9	8.82±5.7	0.000

Note: P<0.05 is considered statistically significant and are presented in bold.

Abbreviations: GBS, Glascow Blatchford score; PVD, portal vein diameter; SBD, splenic bipolar diameter; SVD, splenic vein diameter; PVCi, portal vein congestive index; RARI, renal artery resistive index; OV, esophageal varices; INR, international normalized ratio; Hb, hemoglobin.

Table 4 Outcome of the patients under study according to GBS risk stratification

	GBS 0 (N=6)	GBS <2 (N=30)	GBS 3–6 (N=48)	GBS >6(N=216)
Outcome	-Discharge -Follow-up for 1 month -Endoscopy after 1month is free	-Discharge -Follow-up for 1 month -Endoscopy after 1 month is free	1-Blood transfusion 2-PPI 3-Endoscopy -PUD (34) -Vascular ectasia (8) -GAVE (6)	1-Blood transfusion 2-PPI+Glypressin 3-Endoscopy -PUD (14) -Vascular ectasia (2) -PHG grade II–III (40) -GAVE (16) -OV grade 2 (30) -OV grade 3 (68) -OV grade 4 (46)

Abbreviations: GBS, Glascow Blatchford score; PUD, peptic ulcer disease; PPI, proton pump inhibitors; GAVE, gastric antral vascular ectasia; PHG, portal hypertensive gastropathy; OV, esophageal varices.

Table 5 Correlation of GBS score with endoscopy among patients with critical illness

	Hepatic (144)	Cardiac (78)	Renal (60)	COPD (8)	Pregnant (10)
GBS 0 (n=6)	0	0	0	4	2
GBS 1–2 (n=4)	0	0	0	4	0
GBS 3–6 (n=30)	0	18	6	0	6
GBS >6 (n=260)	144	60	54	0	2
P-value	0.000	0.043	0.02	0.4	0.38
OV score	12.7±2.2	2.1±1.2 (SE)	7.7±3.1	1.7±0.2	8.7±0.7
Endoscopy
OV (n=178)	136	6	30	Non	6
No OV (n=112)	8	72	30	Non	2
P-value	0.000	0.000	0.23	–	0.03

Notes: The patients in each subgroup were stratified according to GBS score and chi-square test was used to detect the statistical significance according to GBS stratification in each subgroup, p<0.05 was considered as statistically significant and are shown in bold.

Abbreviations: GBS, Glascow Blatchford score; OV, esophageal varices; SE, standard of error.

Figure 4 Correlation between OV presence and grade with GBS score value.

Abbreviations: GBS, Glasgow Blatchford score; OV, esophageal varices.

Table 6 Prevalence of OV in study population according to summed OV cirrhometric score

OV score	Low risk (0–4) (n=156)	Intermediate (5–8) (n=6)	High (9–13) (n=72)	Very high (14–17) (n=66)
GBS 0	6 (3.8%)	0	0	0
GBS 1	30 (19.2%)	0	0	0
GBS 3–6	48 (30.7%)	0	0	0
GBS >6	72 (46.3%)	6	72	33
Endoscopy
OV	0	2 (33.3%)	68 (94.4%)	66 (100%)
OV grade	–	GII	GII:20, GIII:36, GIV:12	GIII:32, GIV:34

Abbreviations: GBS, Glascow Blatchford score; OV, esophageal varices

Figure 5 ROC curve for the prediction of OV in validation group.

Abbreviations: ROC, receiver operating characteristic; OV, esophageal varices.