Abstract

NUNEZ, Christian et al. Non-invasive markers to predicate esophagic varices and risk of bleeding in children with portal cavernoma. Gen [online]. 2017, vol.71, n.3, pp.104-109. ISSN 2477-975X.

Introduction: Noninvasive markers for detection of varicose veins and risk of bleeding have been used in portal hypertension due to cirrhosis of the liver. Children with portal cavernoma require pharmacological therapy and endoscopy aimed at eradicating esophageal varices or treatment of variceal hemorrhage for a variable time waiting for surgery.Objective: To determine clinical and laboratory markers that predict esophageal varices and risk of bleeding in children with portal cavernomaduring follow-up. Method: prospective, descriptive and transversal study in 3 years. Variables: Age, sex, bleeding, splenic length by ultrasound, platelet count, fibrinogen, prothrombin time and ratio. Result: 17/21 male (80.95%); mean age 4.85 ± 2.27 years (range: 2-10). All presented splenomegaly, length 133.42 ± 28.55 mm; Platelet count 98.666 / mm 3 ± 46.921, It was determined that there is a greater splenic size,the platelet count was lower, R2 = 0.0992; 19/21 (90.47%) with esophageal varices. Cut-off point for platelet count was <101,500 / mm3 to predict presence of varicose veins, sensitivity 79%, specificity 100% and diagnostic accuracy 80.92% and equal point for risk of bleeding 79%, 57%, and 71.42% respectively. Patients with platelets less than 101,500 / mm3 had a greater chance of bleeding OR = 4.89 (CI95%: 0.68-34.97). Fibrinogen (<201.5mg%) was a good marker for bleeding risk. The platelet index / spleniclength <821.33mm was sensitive and specific for predicting varicose veins and bleeding. The other markers showed lower sensitivity. Conclusion: Platelet count and platelet index / splenic length were useful for predicting the presence of varicose veins and risk of bleeding. In combination with the other markers, it offers a non-invasive predictive profile of great significance for monitoring and surveillance of the child with portal cavernoma

Keywords : Platelet count; fibrinogen; prothrombin time; esophageal varices; portal cavernoma.