Non-invasive predictors of esophageous varices in children and adolescents with chronic liver disease or extrahepatic portal venous obstruction

Objective: to identify non-invasive predictors of esophageal varices in children and adolescents with chronic liver disease or extrahepatic portal venous obstruction (ehpvo). methods: 53 patients younger than 20 years with chronic liver disease or ehpvo and no history of bleeding or prophylactic treatment of esophageal varices (ev) were assessed. they were divided into 2 groups: group i (35 with chronic liver disease) and group ii (18 with ehpvo). their blood count,international normalized ratio (inr),albumin,bilirubin,abdominal ultrasonography and upper endoscopy results were taken. a splenic index was determined by dividing the patients' spleen dimension by its uppermost limit according to their age. the variables were compared to ev presence or not. univariate (chi-square test,fischer's exact test and wilcoxon exact test) and multivariate (logistic regression) analyses were performed. a receiver operating characteristic (roc) curve was constructed and the area under the roc curve was calculated. results: ev were observed in 48.5% of group i patients and in 83.3% of group ii patients. low platelet count (p = 0.0015),splenomegaly (p = 0.0003) and splenic index (p = 0.0007) were statistically significant predictors of ev among group i patients. the multivariate analysis showed low platelet count (odds = 21.7) as an independent predictor of ev in patients with chronic liver disease. conclusion: platelet count,splenic index and platelet-splenic index ratio were predictors of ev in children and adolescents with chronic liver disease. there were no ev predictors among group ii patients. copyright © by sociedade brasileira de pediatria.