https://www.ncbi.nlm.nih.gov/pubmed/27749613

Witters P, Hughes D, Karthikeyan P, Ramakrishna S, Davenport M, Dhawan A, Grammatikopoulos T. J Pediatr Gastroenterol Nutr. 2016 Oct 4.

Abstract

BACKGROUND AND AIMS:
Variceal haemorrhage can be a life-threatening complication of chronic liver disease in children. There is limited evidence about the optimal prophylactic management and selection criteria of children who will benefit from upper gastrointestinal endoscopy.

METHODS:
Children presenting in our centre with suspected portal hypertension or gastrointestinal bleeding and undergoing their first oesophagogastroduodenoscopy between 2005-2012 were included. Clinical, biochemical and radiological data were collected. A separate validation cohort from May 2013 to October 2014 was obtained.

RESULTS:
Data on 124 treatment-naïve patients were collected; 50% had biliary atresia. Thirty five (28%) children presented with gastrointestinal bleeding and overall 79 (64%) had clinically significant (grade II-III) varices. Clinical prediction rule (CPR), aspartate aminotransferase-platelet ratio index (APRI) and varices prediction rule (VPR) had at optimal cut-off sensitivity and specificity of 76% and 59%, 60% and 55%, 80% and 59%, respectively. Logistic regression yielded a new prediction rule of (3 x Albumin (mg/dL)) - (2 x Equivalent adult spleen size (cm)). This King's-Variceal prediction score had a favourable AUROC of 0.772 (0.677-0.867) compared to CPR 0.732 (0.632-0.832). At the optimal cut-off of 76 this yielded a sensitivity and specificity of 72% and 73% and a positive and negative predictive value of 82% and 60% respectively. In the validation cohort AUROC was 0.818 (0.654-0.995) with sensitivity and specificity of 78% and 73%, respectively.

CONCLUSION:
Our new prediction score may be a useful tool in the selection of children with clinically significant varices eligible for a screening endoscopy.