A validated clinical tool for the prediction of varices in PBC: the Newcastle Varices in PBC Score

Imran Patanwala; Peter McMeekin; Ruth Walters; George Mells; Graeme Alexander; Julia Newton; Hemant Shah; Catalina Coltescu; Gideon M Hirschfield; Mark Hudson; Dave Jones

doi:10.1016/j.jhep.2013.04.010

A validated clinical tool for the prediction of varices in PBC: the Newcastle Varices in PBC Score

Imran Patanwala, Peter McMeekin, Ruth Walters, George Mells, Graeme Alexander, Julia Newton, Hemant Shah, Catalina Coltescu, Gideon M Hirschfield, Mark Hudson, Dave Jones

Research output: Contribution to journal › Article › peer-review

25 Citations (Scopus)

Abstract

BACKGROUND & AIMS: Gastro-oesophageal varices (GOV) can occur in early stage primary biliary cirrhosis (PBC), making it difficult to identify the appropriate time to begin screening with oesophageo-gastro-duodenoscopy (OGD). Our aim was to develop and validate a clinical tool to predict the probability of finding GOV in PBC patients.

METHODS: A cross-sectional retrospective study analysing clinical data of 330 PBC patients who underwent an OGD at the Freeman Hospital, Newcastle was used to create a predictive tool, the Newcastle Varices in PBC (NVP) Score, that was externally validated in PBC patients from Cambridge (UK) and Toronto (Canada).

RESULTS: 48% of the Newcastle, 31% of the Cambridge, and 22% of the Toronto cohorts of PBC patients had GOV. Twenty-five percent (95% CI 18-32%) of the Newcastle cohort had GOV diagnosed at an index variceal bleed. Of the others, 37% (95% CI 28-46%) bled after a median of 1.5 years (IQR 3.75). Transplant-free survival was significantly better in those without GOV than in those with GOV (p<0.001), but similar in patients with GOV that bled and those that did not (p=0.1). The NVP score (%Probability)=1/[1+exp^-(9.186+0.001*alkaline phosphatase in IU-0.178*albumin in g/L-0.015*platelet × 10(9)) was validated in 2 external cohorts and was highly discriminant (AUROC 0.86). Cost consequences analyses revealed the NVP score to be as accurate as, but more economical than using either OGD directly or other risk scores for screening PBC patients.

CONCLUSIONS: The NVP score is an inexpensive, non-invasive, externally validated tool that accurately predicts GOV in PBC.

Original language	English
Pages (from-to)	327-35
Number of pages	9
Journal	Journal of Hepatology
Volume	59
Issue number	2
DOIs	https://doi.org/10.1016/j.jhep.2013.04.010
Publication status	Published - Aug 2013

Keywords

Aged
Alkaline Phosphatase
Cohort Studies
Cross-Sectional Studies
Endoscopy, Gastrointestinal
Esophageal and Gastric Varices
Female
Great Britain
Humans
Liver Cirrhosis, Biliary
Male
Middle Aged
Ontario
Platelet Count
Predictive Value of Tests
Retrospective Studies
Risk Factors
Serum Albumin

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10.1016/j.jhep.2013.04.010

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@article{d5c190f9a46e4555a226ebcbb2695c98,

title = "A validated clinical tool for the prediction of varices in PBC: the Newcastle Varices in PBC Score",

abstract = "BACKGROUND & AIMS: Gastro-oesophageal varices (GOV) can occur in early stage primary biliary cirrhosis (PBC), making it difficult to identify the appropriate time to begin screening with oesophageo-gastro-duodenoscopy (OGD). Our aim was to develop and validate a clinical tool to predict the probability of finding GOV in PBC patients.METHODS: A cross-sectional retrospective study analysing clinical data of 330 PBC patients who underwent an OGD at the Freeman Hospital, Newcastle was used to create a predictive tool, the Newcastle Varices in PBC (NVP) Score, that was externally validated in PBC patients from Cambridge (UK) and Toronto (Canada).RESULTS: 48% of the Newcastle, 31% of the Cambridge, and 22% of the Toronto cohorts of PBC patients had GOV. Twenty-five percent (95% CI 18-32%) of the Newcastle cohort had GOV diagnosed at an index variceal bleed. Of the others, 37% (95% CI 28-46%) bled after a median of 1.5 years (IQR 3.75). Transplant-free survival was significantly better in those without GOV than in those with GOV (p<0.001), but similar in patients with GOV that bled and those that did not (p=0.1). The NVP score (%Probability)=1/[1+exp^-(9.186+0.001*alkaline phosphatase in IU-0.178*albumin in g/L-0.015*platelet × 10(9)) was validated in 2 external cohorts and was highly discriminant (AUROC 0.86). Cost consequences analyses revealed the NVP score to be as accurate as, but more economical than using either OGD directly or other risk scores for screening PBC patients.CONCLUSIONS: The NVP score is an inexpensive, non-invasive, externally validated tool that accurately predicts GOV in PBC.",

keywords = "Aged, Alkaline Phosphatase, Cohort Studies, Cross-Sectional Studies, Endoscopy, Gastrointestinal, Esophageal and Gastric Varices, Female, Great Britain, Humans, Liver Cirrhosis, Biliary, Male, Middle Aged, Ontario, Platelet Count, Predictive Value of Tests, Retrospective Studies, Risk Factors, Serum Albumin",

author = "Imran Patanwala and Peter McMeekin and Ruth Walters and George Mells and Graeme Alexander and Julia Newton and Hemant Shah and Catalina Coltescu and Hirschfield, {Gideon M} and Mark Hudson and Dave Jones",

note = "Copyright {\textcopyright} 2013. Published by Elsevier B.V.",

year = "2013",

month = aug,

doi = "10.1016/j.jhep.2013.04.010",

language = "English",

volume = "59",

pages = "327--35",

journal = "Journal of Hepatology",

issn = "0168-8278",

publisher = "Elsevier",

number = "2",

}

TY - JOUR

T1 - A validated clinical tool for the prediction of varices in PBC

T2 - the Newcastle Varices in PBC Score

AU - Patanwala, Imran

AU - McMeekin, Peter

AU - Walters, Ruth

AU - Mells, George

AU - Alexander, Graeme

AU - Newton, Julia

AU - Shah, Hemant

AU - Coltescu, Catalina

AU - Hirschfield, Gideon M

AU - Hudson, Mark

AU - Jones, Dave

PY - 2013/8

Y1 - 2013/8

N2 - BACKGROUND & AIMS: Gastro-oesophageal varices (GOV) can occur in early stage primary biliary cirrhosis (PBC), making it difficult to identify the appropriate time to begin screening with oesophageo-gastro-duodenoscopy (OGD). Our aim was to develop and validate a clinical tool to predict the probability of finding GOV in PBC patients.METHODS: A cross-sectional retrospective study analysing clinical data of 330 PBC patients who underwent an OGD at the Freeman Hospital, Newcastle was used to create a predictive tool, the Newcastle Varices in PBC (NVP) Score, that was externally validated in PBC patients from Cambridge (UK) and Toronto (Canada).RESULTS: 48% of the Newcastle, 31% of the Cambridge, and 22% of the Toronto cohorts of PBC patients had GOV. Twenty-five percent (95% CI 18-32%) of the Newcastle cohort had GOV diagnosed at an index variceal bleed. Of the others, 37% (95% CI 28-46%) bled after a median of 1.5 years (IQR 3.75). Transplant-free survival was significantly better in those without GOV than in those with GOV (p<0.001), but similar in patients with GOV that bled and those that did not (p=0.1). The NVP score (%Probability)=1/[1+exp^-(9.186+0.001*alkaline phosphatase in IU-0.178*albumin in g/L-0.015*platelet × 10(9)) was validated in 2 external cohorts and was highly discriminant (AUROC 0.86). Cost consequences analyses revealed the NVP score to be as accurate as, but more economical than using either OGD directly or other risk scores for screening PBC patients.CONCLUSIONS: The NVP score is an inexpensive, non-invasive, externally validated tool that accurately predicts GOV in PBC.

AB - BACKGROUND & AIMS: Gastro-oesophageal varices (GOV) can occur in early stage primary biliary cirrhosis (PBC), making it difficult to identify the appropriate time to begin screening with oesophageo-gastro-duodenoscopy (OGD). Our aim was to develop and validate a clinical tool to predict the probability of finding GOV in PBC patients.METHODS: A cross-sectional retrospective study analysing clinical data of 330 PBC patients who underwent an OGD at the Freeman Hospital, Newcastle was used to create a predictive tool, the Newcastle Varices in PBC (NVP) Score, that was externally validated in PBC patients from Cambridge (UK) and Toronto (Canada).RESULTS: 48% of the Newcastle, 31% of the Cambridge, and 22% of the Toronto cohorts of PBC patients had GOV. Twenty-five percent (95% CI 18-32%) of the Newcastle cohort had GOV diagnosed at an index variceal bleed. Of the others, 37% (95% CI 28-46%) bled after a median of 1.5 years (IQR 3.75). Transplant-free survival was significantly better in those without GOV than in those with GOV (p<0.001), but similar in patients with GOV that bled and those that did not (p=0.1). The NVP score (%Probability)=1/[1+exp^-(9.186+0.001*alkaline phosphatase in IU-0.178*albumin in g/L-0.015*platelet × 10(9)) was validated in 2 external cohorts and was highly discriminant (AUROC 0.86). Cost consequences analyses revealed the NVP score to be as accurate as, but more economical than using either OGD directly or other risk scores for screening PBC patients.CONCLUSIONS: The NVP score is an inexpensive, non-invasive, externally validated tool that accurately predicts GOV in PBC.

KW - Aged

KW - Alkaline Phosphatase

KW - Cohort Studies

KW - Cross-Sectional Studies

KW - Endoscopy, Gastrointestinal

KW - Esophageal and Gastric Varices

KW - Female

KW - Great Britain

KW - Humans

KW - Liver Cirrhosis, Biliary

KW - Male

KW - Middle Aged

KW - Ontario

KW - Platelet Count

KW - Predictive Value of Tests

KW - Retrospective Studies

KW - Risk Factors

KW - Serum Albumin

U2 - 10.1016/j.jhep.2013.04.010

DO - 10.1016/j.jhep.2013.04.010

M3 - Article

C2 - 23608623

SN - 0168-8278

VL - 59

SP - 327

EP - 335

JO - Journal of Hepatology

JF - Journal of Hepatology

IS - 2

ER -

A validated clinical tool for the prediction of varices in PBC: the Newcastle Varices in PBC Score

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Keywords

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