Liver volume index predicts the risk of esophageal variceal hemorrhage in cirrhotic patients on propranolol prophylaxis

• Published in: The Korean journal of internal medicine 2019, 34(6), , pp.1233-1243
• Main Authors: Kim, Beom Hee, Chung, Jung Wha, Lee, Chung Seop, Jang, Eun Sun, Jeong, Sook-Hyang, Kim, Nayoung, Kim, Jin-Wook
• Format: Article
• Language: English
• Subjects: adrenergic beta-antagonists; Adrenergic beta-Antagonists - adverse effects; Adrenergic beta-Antagonists - therapeutic use; Adult; Aged; cone-beam computed tomography; Decision Support Techniques; esophageal and gastric varices; Esophageal and Gastric Varices - diagnostic imaging; Esophageal and Gastric Varices - etiology; Esophageal and Gastric Varices - prevention & control; Female; Gastrointestinal Hemorrhage - diagnostic imaging; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - prevention & control; Humans; Hypertension, Portal - diagnostic imaging; Hypertension, Portal - drug therapy; Hypertension, Portal - etiology; Liver - diagnostic imaging; Liver Cirrhosis - complications; Liver Cirrhosis - diagnostic imaging; Liver Cirrhosis - drug therapy; Male; Middle Aged; Multidetector Computed Tomography; Nomograms; Organ Size; Original; Predictive Value of Tests; Propranolol - adverse effects; Propranolol - therapeutic use; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; 내과학
• ISSN: 1226-3303; 2005-6648
• DOI: 10.3904/kjim.2018.120

Non-selective β-blockers (NSBBs) are used for primary prevention of esophageal variceal hemorrhage (VH) in patients with portal hypertension, but a significant number of patients develop VH while on NSBB therapy. In this study, we sought to determine whether liver volume can predict the risk of primary prophylaxis failure in cirrhotic patients on NSBB therapy. A retrospective cohort of 309 patients on prophylactic propranolol was analyzed. Liver volume was measured in portal venous phase images of multidetector computed tomography. Predictors of VH were assessed using a Cox proportional hazards model with competing-risks analysis. A nomogram was developed for estimation of the risk of primary prophylaxis failure. During a median follow-up of 36 months, 37 patients on propranolol developed VH. Liver volume index, the ratio of measured-to-expected liver volume, was an independent predictor of VH (adjusted hazard ratio [HR], 2.70; 95% confidence interval [CI], 1.37 to 5.33; p = 0.004) as were the presence of large varices and the absence of ascites. A nomogram-based volume score of > 0.6 was predictive of prophylaxis failure (HR, 7.54; 95% CI, 2.88 to 19.73; p < 0.001). Time-dependent receiver operating characteristic curve analysis revealed that a nomogram-based risk score had significantly better discriminatory power than the North Italian Endoscopy Club index in predicting prophylaxis failure at 6 and 8 years. Liver volume index is an independent predictor of first VH and a nomogram-based volume score stratifies the VH risk in cirrhotic patients on propranolol prophylaxis.