Correlación del índice plaqueta/bazo como factor predictivo de várices esofágicas en paciente con cirrosis hepática
Palabras clave:
cirrosis hepática, várices esofágicas y gástricas, plaquetas, bazo, esplenomegalia
Resumen
Introducción: la cirrosis hepática es la causa más común de obstrucción del flujo sanguíneo en el sistema venoso portal. La hemorragia por várices es una complicación de la cirrosis que define su descompensación.
Objetivo: establecer la correlación del índice plaqueta/bazo como factor predictivo de varices esofágicas en pacientes con cirrosis hepática atendidos en el Hospital Luis Vernaza en el periodo enero del 2022 a diciembre de 2023.
Metodología: se aplicó un diseño analítico retrospectivo de casos. Población: se incluyeron 108 casos de adultos con cirrosis hepática que constaban con muestra analítica de plaquetas y ecografía abdominal con medición del bazo.
Análisis de datos: para establecer si el índice plaqueta/bazo es predictor de várices esofágicas en paciente cirróticos, se procedió hacer un análisis univariado y bivariado entre las variables, obteniendo poder predictivo por regresión logística, con significancia estadística establecida (p<0,05).
Resultados: el punto de corte del índice plaqueta/bazo para valor predictivo fue de <909, con valor de p 0,003, teniendo 3,78 veces más probabilidad de presentar varices esofágicas, incrementando la estancia hospitalaria. La edad promedio fue de 64 años, el sexo fue parejo con el 50,93% para las mujeres y 49,07% para los hombres, la comorbilidad más frecuente fue la diabetes mellitus con el 33,64%. La escala de Child Pugh C se relacionó con mayor presencia de varices esofágicas.
Conclusiones: el índice plaqueta/bazo con un punto de corte <909 predice la presencia de várices esofágicas y prolonga la estancia hospitalaria.
Citas
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16. Sajja KC, Mohan DP, Rockey DC. Age and ethnicity in cirrhosis. J Investig Med [Internet]. 2014 [cited 2024 Feb 8];62(7):920–6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172494/
17. Guevara Benavides SA, Lincango Gualoto FA. Caracterización clínico-epidemiológica de la cirrosis hepática descompensada. Hospital Carlos Andrade Marín. Quito 2022 [Internet] [Tesis]. Riobamba: Universidad Nacional de Chimborazo, Facultad de Ciencias de la Salud, Carrera de Medicina; 2023 [citado 8 Feb 2024]. Disponible en: http://dspace.unach.edu.ec/handle/51000/10513
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21. Mazumder NR, Celaj S, Atiemo K, Daud A, Jackson KL, Kho A, et al. Liver-related mortality is similar among men and women with cirrhosis. J Hepatol [Internet]. 2020 [cited 2024 Feb 8];73(5):1072–81. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572539/
22. Amir Sherazi SA, Goyal H, Tahir H, Achebe I, Warraich MS, Demetria M. Gender differences in cirrhosis: Analysis of demographics, outcomes and healthcare utilization from a national database. [Abstracts: S1218]. Am J Gastroenterol [Internet]. 2021 [cited 2024 Feb 8];116:S562. Available from: https://journals.lww.com/ajg/fulltext/2021/10001/s1218_gender_differences_in_cirrhosis__analysis_of.1219.aspx
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24. Vaz J, Eriksson B, Strömberg U, Buchebner D, Midlöv P. Incidence, aetiology and related comorbidities of cirrhosis: a Swedish population-based cohort study. BMC Gastroenterol [Internet]. 2020 [cited 2024 Feb 8];20(1):84. Available from: https://pubmed.ncbi.nlm.nih.gov/32245414/
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27. Perdomo Puentes JC, Rocha H, Nicolau S, Ferrão G. Effectiveness of the MELD/Na score and the Child–Pugh score for the identification of palliative care needs in patients with cirrhosis of the liver. Indian J Palliat Care [Internet]. 2018 [cited 2024 Feb 8];24(4):526–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6199842/
28. Dumont C, Wuestenberghs F, Lanthier N, Piessevaux H, Dahlqvist G. Malnutrition is highly prevalent in hospitalized cirrhotic patients and associates with a poor outcome. Acta Gastroenterol Belg [Internet]. 2022 [cited 2024 Feb 8];85(2):311–9. Available from: https://pubmed.ncbi.nlm.nih.gov/35709775/
29. Hansen L, Chang MF, Hiatt S, Dieckmann NF, Mitra A, Lyons KS, Lee ChS. Symptom classes in decompensated liver disease. Clin Gastroenterol Hepatol [Internet]. 2022 [cited 2024 Feb 8];20(11):2551-7.e1. Available from: https://www.cghjournal.org/article/S1542-3565(21)01261-1/fulltext
30. Hansen L, Chang MF, Hiatt S, Dieckmann NF, Lyons KS, Lee ChS. Symptom frequency and distress underestimated in decompensated cirrhosis. Dig Dis Sci [Internet]. 2022 [cited 2024 Feb 8];67(8):4234–42. Available from: https://pubmed.ncbi.nlm.nih.gov/34448980/
31. Jamil Z, Durrani AA. Assessing the outcome of patients with liver cirrhosis during hospital stay: A comparison of lymphocyte/monocyte ratio with MELD and Child-Pugh scores. Turk J Gastroenterol [Internet]. 2018 May[cited 2024 Feb 8];29(3):308-315. doi: 10.5152/tjg.2018.17631. Available from: https://pubmed.ncbi.nlm.nih.gov/29755015/
32. Lim N, Desarno MJ, Lidofsky SD, Ganguly E. Hospitalization for variceal hemorrhage in an era with more prevalent cirrhosis. World J Gastroenterol [Internet]. 2014 [cited 2024 Feb 8];20(32):11326–32. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145772/
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34. Altamirano J, Zapata L, Augustin S, Muntaner L, González-Angulo A, Ortiz AL, et al. Predicting 6-week mortality after acute variceal bleeding: role of classification and regression tree analysis. Ann Hepatol [Internet]. 2009;8(4):308–15. Available from: https://pubmed.ncbi.nlm.nih.gov/20009129/
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2. Jakab SS, Garcia-Tsao G. Screening and surveillance of varices in patients with cirrhosis. Clin Gastroenterol Hepatol [Internet]. 2019 [cited 2023 Sept 9];17(1):26–9. Available from: https://pubmed.ncbi.nlm.nih.gov/29551741/
3. Ramírez-Del Pilar R, Yáñez-Montes MC, Enríquez-Peregrino KG, García-Arias MR, Hernández-Mendiola R, López-González DS, et al. Correlación del índice plaqueta/ bazo con el grado de várices esofágicas. Med interna Méx [Internet]. 2017 [citado 11 Ago 2023];33(3):344–50. Disponible en: https://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0186-48662017000300344&lng=es&nrm=iso&tlng=es
4. García Galicia A, Gámez Herrera A, González Bravo EI, Parker Bosquez RA, Montiel Jarquín ÁJ, León Zamudio JA, et al. Cociente plaquetas/bazo para el diagnóstico de várices esofágicas y riesgo de sangrado en pacientes con insuficiencia hepática. Rev Fac Med Hum [Internet]. 2021 [citado 11 Ago 2023];21(2):269–74. Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S2308-05312021000200269&lng=es&nrm=iso&tlng=es
5. Iredale JP, Med Sci F, Pellicoro A. Liver fibrosis: Therapeutic armory 40 Clin Liver Dis (Hoboken) [Internet]. 2015 [cited 2023 Ago 25]; 6(1): 1-4. Available from: https://pubmed.ncbi.nlm.nih.gov/31040974/
6. Parola M, Pinzani M. Liver fibrosis: Pathophysiology, pathogenetic targets and clinical issues. Mol Aspects Med [Internet]. 2019 [cited 2023 Ago 25]; 65:37–55. Available from: https://pubmed.ncbi.nlm.nih.gov/30213667/ Subscription required
7. Alqahtani SA, Jang S. Pathophysiology and management of variceal bleeding. Drugs. 2021;81(6):647–67.
8. Sanyal AJ, Garcia-Pagán JC. Primary prevention of bleeding from esophageal varices in patients with cirrhosis. UpToDate [Internet]. 2025 [cited 2025 Jul 31]. Available from: https://www.uptodate.com/contents/primary-prevention-of-bleeding-from-esophageal-varices-in-patients-with-cirrhosis?search=varices%20esofagicas&source=search_result&selectedTitle=1~136&usage_type=default&display_rank=1
9. Martínez-Marín JD, Marrugo-Padilla K, Garzón-Olarte MA. Diagnostic performance of platelet count/spleen diameter ratio to detect esophageal varices in patients with cirrhosis. Rev Fac Med [Internet]. 2021 [cited 2023 Ago 11];69(3):e78786. Available from: https://revistas.unal.edu.co/index.php/revfacmed/article/view/78786/81518
10. Gunda DW, Kilonzo SB, Mamballah Z, Manyiri PM, Majinge DC, Jaka H, et al. The magnitude and correlates of esophageal varices among newly diagnosed cirrhotic patients undergoing screening fibre optic endoscope before incident bleeding in North-Western Tanzania; a cross-sectional study. BMC Gastroenterol [Internet]. 2019 [cited 2024 Feb 8];19(1):203. Available from: https://pubmed.ncbi.nlm.nih.gov/31783802/
11. Duah A, Nkrumah KN, Tachi K. Oesophageal varices in patients with liver cirrhosis attending a major tertiary hospital in Ghana. Pan Afr Med J [Internet]. 2018 [cited 2024 Feb 8]; 31:230. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6691363/
12. Elghezewi A, Hammad M, El-Dallal M, Mohamed M, Sherif A, Frandah W. Trends in hospitalizations of esophageal varices from 2011 to 2018: A United States nationwide study. Gastroenterology Res [Internet]. 2023 [cited 2024 Feb 8];16(3):171–83. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10284649/
13. Caiza Poaquiza FM, Galárraga Pérez EA. Prevalencia de la cirrosis hepática en pacientes alcohólicos en Ecuador. Revista Científica Arbitrada Multidisciplinaria PENTACIENCIAS [Internet]. 2023 [citado 8 Feb 2024];5(4):661–72. Disponible en: https://www.editorialalema.org/index.php/pentaciencias/article/view/708
14. Bhusal M, Pathak R, Bhandari BK, Jha A, Hamal R, Koirala D, et al. Liver cirrhosis among young adults admitted to the Department of Gastroenterology in a Tertiary Care Centre: A descriptive cross-sectional study. JNMA J Nepal Med Assoc [Internet]. 2023 [cited 2024 Feb 8];61(258):115–8. Available from: https://pubmed.ncbi.nlm.nih.gov/37203980/
15. Stahl EC, Haschak MJ, Popovic B, Brown BN. Macrophages in the aging liver and age-related liver disease. Front Immunol [Internet]. 2018 [cited 2024 Feb 8];9: 2795. Available from: https://pubmed.ncbi.nlm.nih.gov/30555477/
16. Sajja KC, Mohan DP, Rockey DC. Age and ethnicity in cirrhosis. J Investig Med [Internet]. 2014 [cited 2024 Feb 8];62(7):920–6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172494/
17. Guevara Benavides SA, Lincango Gualoto FA. Caracterización clínico-epidemiológica de la cirrosis hepática descompensada. Hospital Carlos Andrade Marín. Quito 2022 [Internet] [Tesis]. Riobamba: Universidad Nacional de Chimborazo, Facultad de Ciencias de la Salud, Carrera de Medicina; 2023 [citado 8 Feb 2024]. Disponible en: http://dspace.unach.edu.ec/handle/51000/10513
18. UPMC HealthBeat. Are men more susceptible to liver disease? [Internet]. Pittsburgh: University of Pittsburgh Medical Center; 2024] [cited 2024 Nov 4]. Available from: https://share.upmc.com/2023/01/gender-and-liver-disease/
19. Roerecke M, Vafaei A, Hasan OSM, Chrystoja BR, Cruz M, Lee R, et al. Alcohol consumption and risk of liver cirrhosis: a systematic review and meta-analysis. Am J Gastroenterol [Internet]. 2019 [cited 2024 Feb 8];114(10):1574–86. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6776700/
20. Rubin JB, Sundaram V, Lai JC. Gender differences among patients hospitalized with cirrhosis in the United States. J Clin Gastroenterol [Internet]. 2020 [cited 2024 Feb 8];54(1):83–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6706332/
21. Mazumder NR, Celaj S, Atiemo K, Daud A, Jackson KL, Kho A, et al. Liver-related mortality is similar among men and women with cirrhosis. J Hepatol [Internet]. 2020 [cited 2024 Feb 8];73(5):1072–81. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572539/
22. Amir Sherazi SA, Goyal H, Tahir H, Achebe I, Warraich MS, Demetria M. Gender differences in cirrhosis: Analysis of demographics, outcomes and healthcare utilization from a national database. [Abstracts: S1218]. Am J Gastroenterol [Internet]. 2021 [cited 2024 Feb 8];116:S562. Available from: https://journals.lww.com/ajg/fulltext/2021/10001/s1218_gender_differences_in_cirrhosis__analysis_of.1219.aspx
23. Jepsen P. Comorbidity in cirrhosis. World J Gastroenterol [Internet]. 2014 [cited 2024 Feb 8];20(23):7223–30. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064068/
24. Vaz J, Eriksson B, Strömberg U, Buchebner D, Midlöv P. Incidence, aetiology and related comorbidities of cirrhosis: a Swedish population-based cohort study. BMC Gastroenterol [Internet]. 2020 [cited 2024 Feb 8];20(1):84. Available from: https://pubmed.ncbi.nlm.nih.gov/32245414/
25. Mukthinuthalapati PKVV, Syed M, Salazar M, Akinyeye S, Fricker Z, Ghabril M, et al. Prevalence of comorbidities in patients with cirrhosis admitted to U.S. Safety Net Hospitals and their impact on clinical phenotype of admission Abstracts: S1007]. Am J Gastroenterol [Internet]. 2018 [cited 2024 Feb 8];113: S566-7. Available from: https://journals.lww.com/ajg/fulltext/2018/10001/prevalence_of_comorbidities_in_patients_with.1007.aspx
26. Pincay Castro RW. Prevalencia del sobrepeso y la obesidad en pacientes con cirrosis hepática, del servicio de gastroenterología del Hospital General Monte Sinaí, en el 2022 [Tesis] [Internet]. Guayaquil: Universidad de las Américas, 2023. [citado 8 Feb 2024]. Disponible en: http://dspace.udla.edu.ec/handle/33000/14720
27. Perdomo Puentes JC, Rocha H, Nicolau S, Ferrão G. Effectiveness of the MELD/Na score and the Child–Pugh score for the identification of palliative care needs in patients with cirrhosis of the liver. Indian J Palliat Care [Internet]. 2018 [cited 2024 Feb 8];24(4):526–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6199842/
28. Dumont C, Wuestenberghs F, Lanthier N, Piessevaux H, Dahlqvist G. Malnutrition is highly prevalent in hospitalized cirrhotic patients and associates with a poor outcome. Acta Gastroenterol Belg [Internet]. 2022 [cited 2024 Feb 8];85(2):311–9. Available from: https://pubmed.ncbi.nlm.nih.gov/35709775/
29. Hansen L, Chang MF, Hiatt S, Dieckmann NF, Mitra A, Lyons KS, Lee ChS. Symptom classes in decompensated liver disease. Clin Gastroenterol Hepatol [Internet]. 2022 [cited 2024 Feb 8];20(11):2551-7.e1. Available from: https://www.cghjournal.org/article/S1542-3565(21)01261-1/fulltext
30. Hansen L, Chang MF, Hiatt S, Dieckmann NF, Lyons KS, Lee ChS. Symptom frequency and distress underestimated in decompensated cirrhosis. Dig Dis Sci [Internet]. 2022 [cited 2024 Feb 8];67(8):4234–42. Available from: https://pubmed.ncbi.nlm.nih.gov/34448980/
31. Jamil Z, Durrani AA. Assessing the outcome of patients with liver cirrhosis during hospital stay: A comparison of lymphocyte/monocyte ratio with MELD and Child-Pugh scores. Turk J Gastroenterol [Internet]. 2018 May[cited 2024 Feb 8];29(3):308-315. doi: 10.5152/tjg.2018.17631. Available from: https://pubmed.ncbi.nlm.nih.gov/29755015/
32. Lim N, Desarno MJ, Lidofsky SD, Ganguly E. Hospitalization for variceal hemorrhage in an era with more prevalent cirrhosis. World J Gastroenterol [Internet]. 2014 [cited 2024 Feb 8];20(32):11326–32. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145772/
33. Solanki S, Haq KF, Chakinala RCh, Khan Z, Aronow WS, Khan MA, et al. Inpatient burden of esophageal varices in the United States: analysis of trends in demographics, cost of care, and outcomes. Ann Transl Med [Internet]. 2019 [cited 2024 Feb 8];7(18):480. Available from: https://pubmed.ncbi.nlm.nih.gov/31700916/
34. Altamirano J, Zapata L, Augustin S, Muntaner L, González-Angulo A, Ortiz AL, et al. Predicting 6-week mortality after acute variceal bleeding: role of classification and regression tree analysis. Ann Hepatol [Internet]. 2009;8(4):308–15. Available from: https://pubmed.ncbi.nlm.nih.gov/20009129/
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