Description

Mendes et al identified risk factors for portal hypertension in patients with nonalcoholic fatty liver disease (NAFLD). These can help to identify a patient who may have esophageal varices. The authors are from Mayo Clinic and University of Kentucky.


Patient selection: nonalcoholic fatty liver disease (NAFLD)

 

Outcome: portal hypertension

 

Portal hypertension can occur due to cirrhosis, Grade 4 hepatic fibrosis or severe fat accumulation

 

Predictors for portal hypertension if liver biopsy available:

(1) thrombocytopenia (platelet count < 150,000 per µL, odds ratio 8.1)

(2) hyperbilirubinemia (total serum bilirubin > 1.0 mg/dL, odds ratio 7.6)

(3) cirrhosis (odds ratio 8.4

(4) obesity (BMI >= 30 kg per square meter, odds ratio 2.5)

 

Predictors for portal hypertension if liver biopsy is not available:

(1) thrombocytopenia (platelet count < 150,000 per µL, odds ratio 16.9)

(2) hyperbilirubinemia (total serum bilirubin > 1.0 mg/dL, odds ratio 5.6)

(3) diabetes mellitus (odds ratio 3)

(4) hypoalbuminemia (serum albumin < 3.5 g/dL, odds ratio 3.9)

 

Predictors for esophageal varices:

(1) thrombocytopenia

(2) type 2 diabetes (fasting blood glucose >= 126 mg/dL or requiring treatment)

(3) splenomegaly by radiologic criteria


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