Non-invasive parameters as predictors of high risk of variceal bleeding in cirrhotic patients | Revista Médica del Hospital General de México

array:23 ["pii" => "S0185106314000304" "issn" => "01851063" "doi" => "10.1016/j.hgmx.2014.09.002" "estado" => "S300" "fechaPublicacion" => "2014-10-01" "aid" => "18" "copyright" => "Sociedad Médica del Hospital General de México" "copyrightAnyo" => "2014" "documento" => "article" "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Med Hosp Gen Mex. 2014;77:179-84" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3318 "formatos" => array:3 [ "EPUB" => 69 "HTML" => 2018 "PDF" => 1231 ] ] "itemSiguiente" => array:18 [ "pii" => "S018510631400047X" "issn" => "01851063" "doi" => "10.1016/j.hgmx.2014.11.002" "estado" => "S300" "fechaPublicacion" => "2014-10-01" "aid" => "22" "copyright" => "Sociedad Médica del Hospital General de México" "documento" => "simple-article" "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Med Hosp Gen Mex. 2014;77:185-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6127 "formatos" => array:3 [ "EPUB" => 52 "HTML" => 5036 "PDF" => 1039 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Clinical case" "titulo" => "Pseudo Intestinal Occlusion: Case Report and Literature Review" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "185" "paginaFinal" => "189" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pseudo-Obstrucción Intestinal: Presentación de un Caso y Revisión de la Literatura" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 668 "Ancho" => 995 "Tamanyo" => 143750 ] ] "descripcion" => array:1 [ "en" => "Evidence of trans-operative distension of the colon with cecum of 18cm in diameter. Small intestine normal." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Mariel González-Calatayud, Gabriela E. Gutiérrez-Uvalle" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Mariel" "apellidos" => "González-Calatayud" ] 1 => array:2 [ "nombre" => "Gabriela E." "apellidos" => "Gutiérrez-Uvalle" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S018510631400047X?idApp=UINPBA00004N" "url" => "/01851063/0000007700000004/v4_201501250140/S018510631400047X/v4_201501250140/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0185106314000316" "issn" => "01851063" "doi" => "10.1016/j.hgmx.2014.10.005" "estado" => "S300" "fechaPublicacion" => "2014-10-01" "aid" => "19" "copyright" => "Sociedad Médica del Hospital General de México" "documento" => "article" "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Med Hosp Gen Mex. 2014;77:173-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2497 "formatos" => array:3 [ "EPUB" => 45 "HTML" => 1636 "PDF" => 816 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Osteoporosis and FRAX risk in patients with liver cirrhosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "173" "paginaFinal" => "178" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Osteoporosis y riesgo FRAX en pacientes con cirrósis hepática" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Azucena I. Casanova-Lara, Pilar A. Peniche-Moguel, José L. Pérez-Hernández, Eduardo Pérez-Torres, Galileo Escobedo González, Chantal J. Córdova-Gallardo" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Azucena I." "apellidos" => "Casanova-Lara" ] 1 => array:2 [ "nombre" => "Pilar A." "apellidos" => "Peniche-Moguel" ] 2 => array:2 [ "nombre" => "José L." "apellidos" => "Pérez-Hernández" ] 3 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Pérez-Torres" ] 4 => array:2 [ "nombre" => "Galileo" "apellidos" => "Escobedo González" ] 5 => array:2 [ "nombre" => "Chantal J." "apellidos" => "Córdova-Gallardo" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0185106314000316?idApp=UINPBA00004N" "url" => "/01851063/0000007700000004/v4_201501250140/S0185106314000316/v4_201501250140/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Non-invasive parameters as predictors of high risk of variceal bleeding in cirrhotic patients" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "179" "paginaFinal" => "184" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "María Andrea Peñaloza-Posada, Eduardo Pérez-Torres, José Luis Pérez-Hernández, Fátima Higuera-de la Tijera" "autores" => array:4 [ 0 => array:2 [ "nombre" => "María Andrea" "apellidos" => "Peñaloza-Posada" ] 1 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Pérez-Torres" ] 2 => array:2 [ "nombre" => "José Luis" "apellidos" => "Pérez-Hernández" ] 3 => array:4 [ "nombre" => "Fátima" "apellidos" => "Higuera-de la Tijera" "email" => array:1 [ 0 => "fatimahiguera@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Gastroenterology Department, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author. Gastroenterology Department, Hospital General de México “Dr. Eduardo Liceaga”, Dr. Balmis 148 Col. Doctores, 06726, Mexico City." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Parámetros no invasivos como predictores de alto riesgo de hemorragia variceal en pacientes cirróticos" ] ] "textoCompleto" => "IntroductionPortal hypertension is a progressive complication of cirrhosis. Portal hypertension leads to the formation of porto-systemic collaterals. Gastroesophageal varices are the most relevant porto-systemic collaterals because their rupture results in variceal bleeding (VB), the most common lethal complication of cirrhosis, associated with a mortality of at least 20% at 6 weeks.<a class="elsevierStyleCrossRefs" href="#bib0005">1–4</a>The most important predictor of variceal bleeding is the variceal size, with the highest risk of first hemorrhage about 15% per year occurring in patients with large varices. Other predictors of hemorrhage are decompensated cirrhosis (Child B/C) and the endoscopic presence of red wale marks.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>Nowadays, the gold standard for assessing portal pressure is the hepatic venous pressure gradient (HVPG), which is obtained by determining the wedged hepatic venous pressure (WHVP) by placing a catheter in the hepatic vein and by inflating a balloon and occluding a larger branch of the hepatic vein, then the WHVP is corrected for increases in intraabdominal pressure by subtracting the free hepatic vein pressure (FHVP) or the intraabdominal inferior vena cava pressure.<a class="elsevierStyleCrossRef" href="#bib0030">6</a>The HVPG have predictive value for the development of gastroesophageal varices,<a class="elsevierStyleCrossRefs" href="#bib0035">7,8</a> and the risk of VB.<a class="elsevierStyleCrossRefs" href="#bib0045">9–11</a> Patients with an HVPG ≥ 20mmHg (measured within 24hours of VB) have been identified as being at a higher risk for early recurrent bleeding within the first week of admission or failure to control bleeding and a higher 1-year mortality compared to those with lower pressure.<a class="elsevierStyleCrossRefs" href="#bib0060">12,13</a> Late rebleeding occurs in approximately 60% of untreated patients, mostly within 1-2 years of the index hemorrhage.<a class="elsevierStyleCrossRefs" href="#bib0070">14,15</a> Limitations to the generalized use of HVPG measurement are the lack of local expertise and poor adherence to guidelines that will ensure reliable and reproducible measurements,<a class="elsevierStyleCrossRef" href="#bib0030">6</a> as well as its invasive nature.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Furthermore, is expensive and not always is available. For this reason, is very important to search for non-invasive, accessible, easy to perform, and reproducible parameters that can help us to identify patients with high risk of bleeding.Many studies have evaluated non-invasive methods such as, low platelet count, spleen size, portal vein diameter, platelet count/spleen size ratio, and they seem to be predictors related to the presence of large or high grade esophageal varices.<a class="elsevierStyleCrossRefs" href="#bib0080">16–32</a> However, there is not sufficient information about if these non-invasive parameters could be used as reliable predictors of high risk of VB that avoid the need for HVPG.The aim of this study was to evaluate if low platelet count, spleen size, platelet count/spleen size ratio, portal vein diameter, blood flow velocity of the portal vein, congestion index of the portal vein, and variceal size could be useful as non-invasive parameters for predicting a high risk of VB in cirrhotic patients.Subjects and methodsStudy designObservational, cross sectional study conducted since February 2011 to February 2013, including cirrhotic patients for any etiology, with portal hypertension and presence of esophageal varices documented by an endoscopic study. Patients with portal hypertension with a prehepatic or posthepatic origin, previous therapy with transjugular intrahepatic porto-systemic shunts, or with history of chirurgic derivation of the portal vein, spleenectomy, thrombosis or cavernomatosis of the portal vein, or with diagnosis of hepatocarcinoma were excluded.Esophageal varices were classified according to Baveno V Consensus<a class="elsevierStyleCrossRef" href="#bib0165">33</a> in small or large varices. We searched for presence or absence of VB. Also patients must have a hepatic doppler ultrasound and laboratory tests to determine Child-Pugh score, and also platelet count, these studies must have been performed with no more than three months of difference regarding to the endoscopic study. Hepatic doppler ultrasound was performed with a Siemens Acuson S2000 equipment with a convex multi-frequency transductor by an expert radiologist, the following measures were performed: Portal vein diameter, blood flow velocity of the portal vein, spleen size (spleen longitudinal axis in centimeters), and with these parameters, were calculated the congestion index of the portal vein, and platelet count/spleen size ratio according to the next formulas:Congestion index of the portal vein=cross-sectional area of the portal vein (cm2)/blood flow velocity of the portal vein (cm/sec)Platelet count/spleen size ratio=platelet count (cell/103)/spleen size (mm)Statistical analysisThe distribution of numerical variables were analyzed with Kolmogorov-Smirnov test, in case of non-normal distribution, logarithmic base 10 transformation was performed to allowed expressed the variables as mean and standard deviation (SD). Qualitative variables were expressed as proportion and percentage. For predictive analysis we considered as the dependent variable “presence of VB” and the independent variables we tested were: Child-Pugh score, platelet count, spleen size, portal vein diameter, platelet count/spleen size ratio, blood flow velocity of the portal vein, congestion index of the portal vein, variceal size. Univariate and multivariate logistic regression were performed. A P value ≤ 0.05 was considered significant. SPSS version 19.0 was employed.ResultsWe included 99 cirrhotic patients with esophageal varices evidenced by endoscopic study, 56 (56.6%) were female, and 43 (43.4%) were male. The mean of age was 57.8±12.2. According to Child-Pugh score, 46 (46.5%) were Child-Pugh A, 41 (41.4%) were Child-Pugh B and 12 (12.1%) were Child-Pugh C. Chronic alcohol intake was the most common cause of cirrhosis counting for 43 (43.4%) patients, followed by non-alcoholic steatohepatitis in 20 (20.2%) patients, 16 (16.2%) patients with chronic viral hepatitis, 14 (14.1%) patients with cryptogenic cirrhosis, and 6 (6.1%)patients with an autoimmune origin. About variceal size, 54 (54.5%) of patients had large varices and 45 (45.5%) had small varices. Regarding to occurrence of VB, 46 (46.5%) presented it, and 53 (53.5%) did not.When we compared the characteristics between cirrhotic patients with VB and patients without VB, we found differences between groups regarding to spleen size, portal diameter, platelet count/spleen size ratio, congestion index of the portal vein, and variceal size (see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). However, in the multivariate analysis, the presence of large varices in the endoscopic study was the best predictor of VB (OR=11.1; 95% CI=3.9 to 32.8, P<0.0001) (see <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>When we evaluated non-invasive parameters: Child-Pugh score, platelet count/spleen size ratio, spleen size, portal vein diameter, portal vein congestion index, as predictive factors of the presence of large esophageal varices, we found that all of them, with exception of Child-Pugh score were predictive factors for the presence of large esophageal varices. The best predictive factor for presence of large esophageal varices was platelet count/spleen size ratio ≤ 909 (OR=2.2; 95% CI=1.3 to 1.8, P=0.003) (see <a class="elsevierStyleCrossRefs" href="#tbl0015">Tables 3 and 4</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia>DiscussionVB is one of the most serious complications of the portal hypertension in cirrhotic patients.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> To assess the degree of portal hypertension in patients with cirrhosis, the gold standard is the measurement of HVPG.<a class="elsevierStyleCrossRefs" href="#bib0005">1,6</a> Gastroesophageal varices develops in patients with a HVPG > 10mmHg, those with an HVPG > 12mmHg are at risk of VB, and those with an HVPG > 20mmHg are at high risk of rebleeding in the first 24hours after a first episode of hemorrhage.<a class="elsevierStyleCrossRefs" href="#bib0005">1–13</a> According to several studies,<a class="elsevierStyleCrossRefs" href="#bib0005">1,5,7,30–33</a> variceal size is one of the most important predictive risk factors for VB. In our study, we corroborate that the presence of large esophageal varices is the main independent predictive risk factor for VB in cirrhotic patients, despite of the class of Child-Pugh. However, is important to note that in our study most of patients were classified as Child-Pugh A and B, only a few patients were classified as Child-Pugh C. Other studies have found that Child-Pugh B/C patients have the greatest risk for develop large esophageal varices and VB.<a class="elsevierStyleCrossRefs" href="#bib0005">1,34,35</a>Several previous studies have shown independent parameters like splenomegaly,<a class="elsevierStyleCrossRefs" href="#bib0170">34,36–39</a> low platelet count,<a class="elsevierStyleCrossRefs" href="#bib0170">34,37–39</a> portal vein diameter, <a class="elsevierStyleCrossRefs" href="#bib0170">34,40</a> platelet count/spleen diameter ratio,<a class="elsevierStyleCrossRefs" href="#bib0170">34,41,42</a> congestion index of the portal vein <a class="elsevierStyleCrossRef" href="#bib0215">43</a> as significant predictors for the presence of esophageal varices. In our study, we also found that spleen size, platelet count/spleen size ratio, portal vein diameter, spleen size and congestion index of the portal vein were independent predictors for the presence of large esophageal varices (P=0.01), low platelet count was also found in patients with large esophageal varices (P=0.04). However, when we evaluated these non-invasive parameters as predictors of high risk of VB, only the portal vein diameter ≥ 13mm was a predictive factor (P=0.03) according to our multivariate analysis.Primary prophylaxis to prevent the first VB is indicated in cirrhotic patients with large varices, either non-selective beta-blockers (NSBB) or endoscopic variceal ligation (EBL) can be used.<a class="elsevierStyleCrossRef" href="#bib0220">44</a> The advantages of NSBB are that their cost is low, expertise is not required for their use, and they may prevent other complications, such as bleeding from portal hypertensive gastropathy, ascites, and spontaneous bacterial peritonitis because they reduce portal pressure. Additionally, many patients prefer to avoid endoscopic procedures because of their invasive nature.<a class="elsevierStyleCrossRef" href="#bib0225">45</a> Since our study corroborates that non-invasive ultrasonographic parameters are capable to identify patients with large varices, and large varices are a main risk factor for VB, we propose that in selected patients, or when endoscopy is not available, non-invasive ultrasonographic parameters could be enough to decide start primary prophylaxis with NSBB.A limitation of our study is its retrolective character. Furthermore, in our institution we do not count with equipment to perform HPVG, therefore we could not determine it in our patients, as we did not count with the gold standard to prognosis the risk of VB we considered inappropriate to determine the sensibility, specificity, and predictive values for variceal size and portal vein diameter as tools for predict high risk of VB in cirrhotic patients.Prospective studies to evaluate the non-invasive parameters proposed in this study are necessary to validate our findings. Since we collected the ultrasonographic data from medical records, we had not the opportunity to evaluate the inter-observer concordance.ConclusionsThe presence of large esophageal varices is the most important predictive risk factor for the occurrence of VB, independently of the class of Child-Pugh. Additionally, the portal vein diameter ≥ 13mm is a non-invasive parameter related to high risk of VB. Therefore, presence of large varices and a portal vein diameter ≥ 13mm can be used as predictors of high risk of VB when the measure of HPVG is not available. However, other non-invasive parameters seem to be not useful and cannot replace the determination of the HPVG.Our study confirms that in medical centers where endoscopic study is not available, non-invasive parameters such as, portal vein diameter ≥ 13mm, spleen size ≥ 13.5cm, platelet count/spleen size ≤ 909, and the portal vein congestion index > 0.135 could be useful tools to predict the presence of large esophageal varices in cirrhotic patients independently of the class of Child-Pugh. The most useful of them, is platelet count/spleen size ratio. Therefore, these parameters could guide the decision to start primary prophylaxis.Conflict of interestAll authors declare have not conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres414094" "titulo" => array:6 [ 0 => "Abstract" 1 => "Introduction" 2 => "Objective" 3 => "Subjects and methods" 4 => "Results" 5 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec389748" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres414095" "titulo" => array:6 [ 0 => "Resumen" 1 => "Introducción" 2 => "Objetivo" 3 => "Sujetos y métodos" 4 => "Resultados" 5 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec389749" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Subjects and methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-08-14" "fechaAceptado" => "2014-09-03" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec389748" "palabras" => array:4 [ 0 => "Non-invasive parameters" 1 => "Predictive factors" 2 => "Variceal bleeding" 3 => "Cirrhosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec389749" "palabras" => array:4 [ 0 => "Parámetros no invasivos" 1 => "Factores predictivos" 2 => "Hemorragia variceal" 3 => "Cirrosis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "IntroductionVariceal bleeding (VB) is a serious complication in cirrhotic patients. Hepatic pressure venous gradient (HPVG) is the gold standard to assess high risk of VB, but, this is not always available and is an invasive method. Therefore is necessary to explore if non-invasive parameters are useful as predictive factors of high risk of VB. ObjectiveTo evaluate if low platelet count, spleen size, platelet count/spleen size ratio, portal vein diameter, blood flow velocity of the portal vein, congestion index of the portal vein, and variceal size could be useful as non-invasive parameters for predicting high risk of VB in cirrhotic patients. Subjects and methodsObservational, cross sectional study, that includes 99 cirrhotic patients with esophageal varices. For predictive analysis we considered as the dependent variable “presence of VB” and the independent variables we tested were: Child-Pugh score, platelet count, spleen size, portal vein diameter, platelet count/spleen size ratio, blood flow velocity of the portal vein, congestion index of the portal vein, variceal size. Univariate and multivariate logistic regression were performed. Results99 cirrhotics with esophageal varices were included, 56 (56.6%) were female, the mean of age was 57.8±12.2. About variceal size, 54 (54.5%) of patients had large varices. Regarding to occurrence of VB, 46 (46.5%) presented it. In the multivariate analysis, the presence of large varices in the endoscopic study was the best predictor of VB (OR=11.1; 95% CI=3.9 to 32.8, P<0.0001). Portal vein diameter ≥ 13mm results with an OR=5.0; 95% CI=1.1 to 21.7, P=0.03 ConclusionsThe presence of large esophageal varices is the most important predictive risk factor for the occurrence of VB, independently of the class of Child-Pugh. Additionally, the portal vein diameter ≥ 13mm is a non-invasive parameter related to high risk of VB. Therefore, these factors could be used as predictors of high risk of VB when the measure of HPVG is not available." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa hemorragia variceal (HV) es una complicación grave en pacientes cirróticos. El gradiente de presión venosa hepática (GPVH) es el estándar de oro para clasificar pacientes con alto riesgo de HV, sin embargo, este no siempre está disponible y es un método invasivo. Por tanto, es necesario explorar si parámetros no invasivos son útiles como factores predictores de alto riesgo de HV. ObjetivoEvaluar si la baja cuenta plaquetaria, tamaño del bazo, cociente cuenta plaquetaria/tamaño del bazo, diámetro portal, velocidad del flujo portal, índice de congestión portal, y tamaño variceal podrían ser útiles como parámetros no invasivos para predecir alto riesgo de HV en pacientes cirróticos. Sujetos y métodosEstudio observacional, transversal, que incluyó 99 pacientes cirróticos con varices esofágicas. Para el análisis predictivo consideramos como la variable dependiente “presencia de HV”, y como variables independientes: estadio de Child-Pugh, cuenta plaquetaria, tamaño del bazo, diámetro portal, cociente cuenta plaquetaria/tamaño del bazo, velocidad del flujo portal, índice de congestión portal, tamaño variceal. Realizamos análisis de regresión logística uni y multivariado. ResultadosSe incluyeron 99 pacientes cirróticos con varices esofágicas, 56 (56.6%) fueron mujeres, la media de edad fue 57.8±12.2. Respecto al tamaño variceal, 54 (54.5%) tuvieron varices grandes. Respecto a la ocurrencia de HV, 46 (46.5%) la presentaron. En el análisis multivariado, la presencia de varices grandes por endoscopia fue el mejor predictor de HV (RM=11.1; IC 95%=3.9 a 32.8, P<0.0001). El diámetro portal resultó con una RM=5.0; IC 95%=1.1 to 21.7, P=0.03. ConclusionesLa presencia de varices esofágicas grandes es el factor predictivo más importante de la ocurrencia de HV, independiente de la clase de Child-Pugh. Adicionalmente, el diámetro portal ≥ 13mm es un parámetro no invasivo relacionado con alto riesgo de HV. Por tanto, estos factores podrían ser utilizados como predictores de alto riesgo de HV cuando en GPVH no este disponible." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Qualitative variables are expressed as frequency and percent. Numerical variables are expressed as mean and standard deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cirrhotic patients with variceal bleedingn=46 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cirrhotic patients without variceal bleedingn=53 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Child-Pugh</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21 (45.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 (47.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 (41.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 (41.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (13.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (11.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Platelet count (cell/10<a class="elsevierStyleCrossRef" href="#bib0015">3</a>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">104.1±44.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">120.7±72.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Spleen size (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.6±2.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.4±2.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Portal diameter (mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.9±2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.3±3.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Platelet count/spleen size ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">820.5±445.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1061.1±744.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Blood flow velocity of the portal vein (cm/seg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.2±5.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.8±8.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Congestion index of the portal vein \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.135±0.51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.109±0.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Variceal size (Large) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38 (38.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 (16.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">< 0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab646288.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Univariate analysis comparing characteristics between cirrhotic patients with and without variceal bleeding." ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "OR=Odds ratio.95% CI=95% Confidence interval." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Variceal size(Large) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.1 (3.9 – 32.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">< 0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Portal vein diameter(≥ 13 mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.0 (1.1 – 21.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Spleen size (≥ 13.5 cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0 (0.9 – 1.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Platelet count/spleen size ratio (≤ 909) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0 (0.9 – 1.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Congestion index of the portal vein (> 0.135) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0 (0.0 – 0.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab646287.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Multivariate analysis to determine predictive non-invasive parameters for high risk of variceal bleeding." ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Qualitative variables are expressed as frequency and percent. Numerical variables are expressed as mean and standard deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cirrhotic patients with large esophageal varices n=54 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cirrhotic patients with small esophageal varices n=45 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Child-Pugh</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20 (37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 (57.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 (31.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (11.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Platelet count (cell/10<a class="elsevierStyleCrossRef" href="#bib0015">3</a>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">101.2±52.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">127.1±69.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Spleen size (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.6±2.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.2±2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Portal diameter (mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.8±3.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.2±3.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Platelet count/spleen size ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">802.2±500.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1125.8±728.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Blood flow velocity of the portal vein (cm/sec) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.4±7.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.0±7.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Congestion index of the portal vein \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.135±0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.105±0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab646286.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Univariate analysis comparing characteristics between cirrhotic patients with large and with small esophageal varices." ] ] 3 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "OR=Odds ratio; 95% CI=95% confidence interval." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Small varices n=45 (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Large varices n=54 (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Platelet count/spleen size ratio (≤909) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (46) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 (75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.003 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.2 (1.3 a 3.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Spleen size (≥ 13.5cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (31) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (55) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6 (1.1 a 2.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Portal vein diameter (≥13mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (31) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 (53) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5 (1.1 a 2.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Congestion index of the portal vein (>0.135) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 (53) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5 (1.1 a 2.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab646289.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Multivariate analysis to identify predictive non-invasive parameters for presence of large esophageal varices in cirrhotic patients." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:45 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Practice Guidelines Committee of the American Association for the Study of Liver Diseases and Practice Parameters Committee of American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Garcia-Tsao" 1 => "A.J. Sanyal" 2 => "N.D. Grace" 3 => "W. Carey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.21907" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2007" "volumen" => "46" "paginaInicial" => "922" "paginaFinal" => "938" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17879356" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improved survival after variceal hemorrhage over an 11-year period in the Department of Veterans Affairs" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H.B. El-Serag" 1 => "J.E. Everhart" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1572-0241.2000.03376.x" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2000" "volumen" => "95" "paginaInicial" => "3566" "paginaFinal" => "3573" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11151893" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Upper digestive bleeding in cirrhosis Post-therapeutic outcome and prognostic indicators" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. D’Amico" 1 => "R. de Franchis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/jhep.2003.50385" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2003" "volumen" => "38" "paginaInicial" => "599" "paginaFinal" => "612" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12939586" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improved survival after variceal bleeding in patients with cirrhosis over the past two decades" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N. Carbonell" 1 => "A. Pauwels" 2 => "L. Serfaty" 3 => "O. Fourdan" 4 => "V.G. Levy" 5 => "R. Poupon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.20339" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2004" "volumen" => "40" "paginaInicial" => "652" "paginaFinal" => "659" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15349904" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "The North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM198810133191505" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1988" "volumen" => "319" "paginaInicial" => "983" "paginaFinal" => "989" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3262200" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The hepatic venous pressure gradient: Anything worth doing should be done right" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.J. Groszmann" 1 => "S. Wongcharatrawee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.20062" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2004" "volumen" => "39" "paginaInicial" => "280" "paginaFinal" => "283" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14767976" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Portal pressure, presence of gastroesophageal varices and variceal bleeding" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Garcia-Tsao" 1 => "R.J. Groszmann" 2 => "R.L. Fisher" 3 => "H.O. Conn" 4 => "C.E. Atterbury" 5 => "M. Glickman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "1985" "volumen" => "5" "paginaInicial" => "419" "paginaFinal" => "424" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3873388" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "for the Portal Hypertension Collaborative Group Betablockers to prevent gastroesophageal varices in patients with cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.J. Groszmann" 1 => "G. Garcia-Tsao" 2 => "J. Bosch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa044456" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2005" "volumen" => "353" "paginaInicial" => "2254" "paginaFinal" => "2261" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16306522" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemodynamic events in a prospective randomized trial of propranolol vs placebo in the prevention of the first variceal hemorrhage" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.J. Groszmann" 1 => "J. Bosch" 2 => "N. Grace" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "1990" "volumen" => "99" "paginaInicial" => "1401" "paginaFinal" => "1407" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2210246" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relation between portal pressure response to pharmacotherapy and risk of recurrent variceal haemorrhage in patients with cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Feu" 1 => "J.C. Garcia-Pagan" 2 => "J. Bosch" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Lancet" "fecha" => "1995" "volumen" => "346" "paginaInicial" => "1056" "paginaFinal" => "1059" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7564785" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S001650850702032X" "estado" => "S300" "issn" => "00165085" ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "HVPG reduction and prevention of variceal bleeding in cirrhosis. A systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. D’Amico" 1 => "J.C. Garcia-Pagan" 2 => "A. Luca" 3 => "J. Bosch" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Gastroenterology" "fecha" => "2006" "volumen" => "131" "paginaInicial" => "1624" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognostic value of early measurements of portal pressure in acute variceal bleeding" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E. Moitinho" 1 => "A. Escorsell" 2 => "J.C. Bandi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "1999" "volumen" => "117" "paginaInicial" => "626" "paginaFinal" => "631" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10464138" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influence of portal hypertension and its early decompression by TIPS placement on the outcome of variceal bleeding" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Monescillo" 1 => "F. Martinez-Lagares" 2 => "L. Ruiz del Arbol" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.20386" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2004" "volumen" => "40" "paginaInicial" => "793" "paginaFinal" => "801" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15382120" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pharmacological treatment of portal hypertension: an evidence-based approach" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. D’Amico" 1 => "L. Pagliaro" 2 => "J. Bosch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-2007-1007133" "Revista" => array:6 [ "tituloSerie" => "Semin Liver Dis" "fecha" => "1999" "volumen" => "19" "paginaInicial" => "475" "paginaFinal" => "505" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10643630" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevention of variceal rebleeding" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Bosch" 1 => "J.C. Garcia-Pagan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(03)12778-X" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2003" "volumen" => "361" "paginaInicial" => "952" "paginaFinal" => "954" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12648985" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and predictors of esophageal varices in patients with primary sclerosing cholangitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.O. Zein" 1 => "K.D. Lindor" 2 => "P. Angulo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.20029" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2004" "volumen" => "39" "paginaInicial" => "204" "paginaFinal" => "210" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14752839" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Application of the platelet count/spleen diameter ratio to rule out the presence of oesophageal varices in patients with cirrhosis: a validation study based on follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E.G. Giannini" 1 => "F. Botta" 2 => "P. Borro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.dld.2005.05.007" "Revista" => array:6 [ "tituloSerie" => "Dig Liver Dis" "fecha" => "2005" "volumen" => "37" "paginaInicial" => "779" "paginaFinal" => "785" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15996912" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices: results of a multicenter, prospective, validation study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E.G. Giannini" 1 => "A. Zaman" 2 => "A. Kreil" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1572-0241.2006.00874.x" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2006" "volumen" => "101" "paginaInicial" => "2511" "paginaFinal" => "2519" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17029607" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prediction of large esophageal varices in patients with cirrhosis of the liver using clinical, laboratory and imaging parameters" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.K. Sharma" 1 => "R. Aggarwal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1440-1746.2006.04501.x" "Revista" => array:6 [ "tituloSerie" => "J Gastroenterol Hepatol" "fecha" => "2007" "volumen" => "22" "paginaInicial" => "1909" "paginaFinal" => "1915" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17914969" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Platelet count is not a predictor of the presence or development of gastroesophageal varices in cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.A. Qamar" 1 => "N.D. Grace" 2 => "R.J. Groszmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.21941" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2008" "volumen" => "47" "paginaInicial" => "153" "paginaFinal" => "159" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18161700" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Platelet count/spleen diameter ratio for non-invasive prediction of high risk esophageal varices in cirrhotic patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Barrera" 1 => "A. Riquelme" 2 => "A. Soza" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Hepatol" "fecha" => "2009" "volumen" => "8" "paginaInicial" => "325" "paginaFinal" => "330" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20009131" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The predictors of the presence of varices in patients with primary sclerosing cholangitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Treeprasertsuk" 1 => "K.V. Kowdley" 2 => "V.A. Luketic" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.23432" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2010" "volumen" => "51" "paginaInicial" => "1302" "paginaFinal" => "1310" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20044810" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utilization of platelet count spleen diameter ratio in predicting the presence of esophageal varices in patients with cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Schwarzenberger" 1 => "T. Meyer" 2 => "V. Golla" 3 => "N.P. Sahdala" 4 => "A.D. Min" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCG.0b013e3181a745ff" "Revista" => array:6 [ "tituloSerie" => "J Clin Gastroenterol" "fecha" => "2010" "volumen" => "44" "paginaInicial" => "146" "paginaFinal" => "150" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19593164" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Noninvasive prediction of large esophageal varices in chronic liver disease patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Sarangapani" 1 => "C. Shanmugam" 2 => "M. Kalyanasundaram" 3 => "B. Rangachari" 4 => "P. Thangavelu" 5 => "J.K. Subbarayan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/1319-3767.58767" "Revista" => array:6 [ "tituloSerie" => "Saudi J Gastroenterol" "fecha" => "2010" "volumen" => "16" "paginaInicial" => "38" "paginaFinal" => "42" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20065573" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prediction of esophageal varices in hepatic cirrhosis by noninvasive markers" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.R. Tafarel" 1 => "L.H. Tolentino" 2 => "L.M. Correa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MEG.0b013e3283488a88" "Revista" => array:6 [ "tituloSerie" => "Eur J Gastroenterol Hepatol" "fecha" => "2011" "volumen" => "23" "paginaInicial" => "754" "paginaFinal" => "758" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21691209" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence, prevalence, and clinical significance of abnormal hematologic indices in compensated cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.A. Qamar" 1 => "N.D. Grace" 2 => "R.J. Groszmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cgh.2009.02.021" "Revista" => array:6 [ "tituloSerie" => "Clin Gastroenterol Hepatol" "fecha" => "2009" "volumen" => "7" "paginaInicial" => "689" "paginaFinal" => "695" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19281860" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Platelet count/spleen diameter ratio to predict the presence of esophageal varices in patients with cirrhosis: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Chawla" 1 => "A. Katz" 2 => "B.M. Attar" 3 => "A. Gupta" 4 => "D.S. Sandhu" 5 => "R. Agarwal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MEG.0b013e3283505015" "Revista" => array:6 [ "tituloSerie" => "Eur J Gastroenterol Hepatol" "fecha" => "2012" "volumen" => "24" "paginaInicial" => "431" "paginaFinal" => "436" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22410714" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-invasive model predicting clinically-significant portal hypertension in patients with advanced fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.H. Park" 1 => "T.E. Park" 2 => "Y.M. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1440-1746.2009.05904.x" "Revista" => array:6 [ "tituloSerie" => "J Gastroenterol Hepatol" "fecha" => "2009" "volumen" => "24" "paginaInicial" => "1289" "paginaFinal" => "1293" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19682196" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Derivation of a clinical prediction rule for the noninvasive diagnosis of varices in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.C. Gana" 1 => "D. Turner" 2 => "E.A. Roberts" 3 => "S.C. Ling" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MPG.0b013e3181b64437" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Gastroenterol Nutr" "fecha" => "2010" "volumen" => "50" "paginaInicial" => "188" "paginaFinal" => "193" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19966576" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management and Treatment of Patients With Cirrhosis and Portal Hypertension: Recomendations From the Department of Veterans Affairs Hepatiis C Resource Center Program and the National Hepatitis C Program" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. García-Tsao" 1 => "J. Lim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/ajg.2009.191" "Revista" => array:7 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2009" "volumen" => "104" "paginaInicial" => "1802" "paginaFinal" => "1829" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19455106" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S001650850800913X" "estado" => "S300" "issn" => "00165085" ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessing portal hypertension in liver diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Berzigotti" 1 => "S. Seijo" 2 => "E. Reverter" 3 => "J. Bosch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1586/egh.12.83" "Revista" => array:6 [ "tituloSerie" => "Expert Rev Gastroenterol Hepatol" "fecha" => "2013" "volumen" => "7" "paginaInicial" => "141" "paginaFinal" => "155" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23363263" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathophysiology of portal Hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Bosch" 1 => "P. Pizcueta" 2 => "F. Feu" 3 => "M. Fernandez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gastroenterol Clin North Am." "fecha" => "1992" "volumen" => "21" "paginaInicial" => "1" "paginaFinal" => "14" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1568770" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Revising consensus in portal hypertension: Report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. De Franchis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhep.2010.06.004" "Revista" => array:6 [ "tituloSerie" => "J Hepatol" "fecha" => "2010" "volumen" => "53" "paginaInicial" => "762" "paginaFinal" => "768" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20638742" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-invasive predictors of esophageal varices" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.V. Cherian" 1 => "N. Deepak" 2 => "R.P. Ponnusamy" 3 => "A. Somasundaram" 4 => "V. Jayanthi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/1319-3767.74470" "Revista" => array:6 [ "tituloSerie" => "Saudi J Gastroenterol" "fecha" => "2011" "volumen" => "17" "paginaInicial" => "64" "paginaFinal" => "68" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21196656" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk factors for the presence of varices in cirrhotic patients without a history of variceal hemorrhage" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Zaman" 1 => "T. Becker" 2 => "J. Lapidus" 3 => "K. Benner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Intern Med" "fecha" => "2001" "volumen" => "161" "paginaInicial" => "2564" "paginaFinal" => "2570" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11718587" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Correlation between splenomegaly and oesophageal varices in patients with liver cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.N. Amarapurkar" 1 => "S.S. Parikh" 2 => "K. Shankaran" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-2007-1009036" "Revista" => array:6 [ "tituloSerie" => "Endoscopy." "fecha" => "1994" "volumen" => "26" "paginaInicial" => "563" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7828573" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0016508511001387" "estado" => "S300" "issn" => "00165085" ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of large esophageal varices in patients with cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N. Chalasani" 1 => "T.F. Imperiale" 2 => "A. Ismail" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1572-0241.1999.1539_a.x" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol." "fecha" => "1999" "volumen" => "94" "paginaInicial" => "3285" "paginaFinal" => "3291" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10566731" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prediction of esophageal varices in patients with cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Madhotra" 1 => "H.E. Mulcahy" 2 => "I. Willner" 3 => "A. Reuben" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Gastroenterol." "fecha" => "2002" "volumen" => "34" "paginaInicial" => "81" "paginaFinal" => "85" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11743252" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0195" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-invasive predictors of the presence of large oesophageal varices in patients with cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K.C. Thomopoulos" 1 => "C. Labropoulou-Karatza" 2 => "K.P. Mimidis" 3 => "E.C. Katsakoulis" 4 => "G. Iconomou" 5 => "V.N. Nikolopoulou" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Dig Liver Dis." "fecha" => "2003" "volumen" => "35" "paginaInicial" => "473" "paginaFinal" => "478" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12870732" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0200" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Schepis" 1 => "C. Camma" 2 => "D. Niceforo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/jhep.2001.21410" "Revista" => array:6 [ "tituloSerie" => "Hepatology." "fecha" => "2001" "volumen" => "33" "paginaInicial" => "333" "paginaFinal" => "338" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11172334" "web" => "Medline" ] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0205" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Platelet count/spleen diameter ratio: Proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E. Giannini" 1 => "F. Botta" 2 => "P. Borro" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gut." "fecha" => "2003" "volumen" => "52" "paginaInicial" => "1200" "paginaFinal" => "1205" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12865282" "web" => "Medline" ] ] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0210" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices: Results of a multicenter, prospective, validation study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E. Giannini" 1 => "A. Zaman" 2 => "A. Kreil" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1572-0241.2006.00874.x" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol." "fecha" => "2006" "volumen" => "101" "paginaInicial" => "2511" "paginaFinal" => "2519" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17029607" "web" => "Medline" ] ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0215" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Congestion Index of the Portal vein" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Moriyasu" 1 => "O. Nishida" 2 => "N. Ban" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "American Roentgen Ray Society" "fecha" => "1986" "volumen" => "12" "paginaInicial" => "735" "paginaFinal" => "739" ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0220" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Banding ligation versus betablockers as primary prophylaxis in esophageal varices: systematic review of randomized trials" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L.L. Gluud" 1 => "S. Klingenberg" 2 => "D. Nikolova" 3 => "C. Gluud" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1572-0241.2007.01564.x" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2007" "volumen" => "102" "paginaInicial" => "2842" "paginaFinal" => "2848" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18042114" "web" => "Medline" ] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0225" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of varices and variceal hemorrhage in cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. García-Tsao" 1 => "J. Bosch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMra0901512" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2010" "volumen" => "362" "paginaInicial" => "823" "paginaFinal" => "832" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20200386" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/01851063/0000007700000004/v4_201501250140/S0185106314000304/v4_201501250140/en/main.assets" "Apartado" => array:4 [ "identificador" => "13821" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Artículos originales" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/01851063/0000007700000004/v4_201501250140/S0185106314000304/v4_201501250140/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0185106314000304?idApp=UINPBA00004N"]

Statistics

Original Article

Non-invasive parameters as predictors of high risk of variceal bleeding in cirrhotic patients

Parámetros no invasivos como predictores de alto riesgo de hemorragia variceal en pacientes cirróticos

María Andrea Peñaloza-Posada, Eduardo Pérez-Torres, José Luis Pérez-Hernández, Fátima Higuera-de la Tijera

Corresponding author

fatimahiguera@hotmail.com

Corresponding author. Gastroenterology Department, Hospital General de México “Dr. Eduardo Liceaga”, Dr. Balmis 148 Col. Doctores, 06726, Mexico City.

Gastroenterology Department, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City

Read

5402

Times
was read the article

1634

Total PDF

3768

Total HTML

Share statistics

 array:23 [
  "pii" => "S0185106314000304"
  "issn" => "01851063"
  "doi" => "10.1016/j.hgmx.2014.09.002"
  "estado" => "S300"
  "fechaPublicacion" => "2014-10-01"
  "aid" => "18"
  "copyright" => "Sociedad M&#233;dica del Hospital General de M&#233;xico"
  "copyrightAnyo" => "2014"
  "documento" => "article"
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Rev Med Hosp Gen Mex. 2014;77:179-84"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 3318
    "formatos" => array:3 [
      "EPUB" => 69
      "HTML" => 2018
      "PDF" => 1231
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S018510631400047X"
    "issn" => "01851063"
    "doi" => "10.1016/j.hgmx.2014.11.002"
    "estado" => "S300"
    "fechaPublicacion" => "2014-10-01"
    "aid" => "22"
    "copyright" => "Sociedad M&#233;dica del Hospital General de M&#233;xico"
    "documento" => "simple-article"
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "crp"
    "cita" => "Rev Med Hosp Gen Mex. 2014;77:185-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 6127
      "formatos" => array:3 [
        "EPUB" => 52
        "HTML" => 5036
        "PDF" => 1039
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Clinical case</span>"
      "titulo" => "Pseudo Intestinal Occlusion: Case Report and Literature Review"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "185"
          "paginaFinal" => "189"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Pseudo-Obstrucción Intestinal: Presentación de un Caso y Revisión de la Literatura"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 4"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr4.jpeg"
              "Alto" => 668
              "Ancho" => 995
              "Tamanyo" => 143750
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Evidence of trans-operative distension of the colon with cecum of 18<span class="elsevierStyleHsp" style=""></span>cm in diameter. Small intestine normal.</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Mariel González-Calatayud, Gabriela E. Gutiérrez-Uvalle"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Mariel"
              "apellidos" => "González-Calatayud"
            ]
            1 => array:2 [
              "nombre" => "Gabriela E."
              "apellidos" => "Gutiérrez-Uvalle"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S018510631400047X?idApp=UINPBA00004N"
    "url" => "/01851063/0000007700000004/v4_201501250140/S018510631400047X/v4_201501250140/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S0185106314000316"
    "issn" => "01851063"
    "doi" => "10.1016/j.hgmx.2014.10.005"
    "estado" => "S300"
    "fechaPublicacion" => "2014-10-01"
    "aid" => "19"
    "copyright" => "Sociedad M&#233;dica del Hospital General de M&#233;xico"
    "documento" => "article"
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Med Hosp Gen Mex. 2014;77:173-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2497
      "formatos" => array:3 [
        "EPUB" => 45
        "HTML" => 1636
        "PDF" => 816
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Osteoporosis and FRAX risk in patients with liver cirrhosis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "173"
          "paginaFinal" => "178"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Osteoporosis y riesgo FRAX en pacientes con cirrósis hepática"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Azucena I. Casanova-Lara, Pilar A. Peniche-Moguel, José L. Pérez-Hernández, Eduardo Pérez-Torres, Galileo Escobedo González, Chantal J. Córdova-Gallardo"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Azucena I."
              "apellidos" => "Casanova-Lara"
            ]
            1 => array:2 [
              "nombre" => "Pilar A."
              "apellidos" => "Peniche-Moguel"
            ]
            2 => array:2 [
              "nombre" => "José L."
              "apellidos" => "Pérez-Hernández"
            ]
            3 => array:2 [
              "nombre" => "Eduardo"
              "apellidos" => "Pérez-Torres"
            ]
            4 => array:2 [
              "nombre" => "Galileo"
              "apellidos" => "Escobedo González"
            ]
            5 => array:2 [
              "nombre" => "Chantal J."
              "apellidos" => "Córdova-Gallardo"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0185106314000316?idApp=UINPBA00004N"
    "url" => "/01851063/0000007700000004/v4_201501250140/S0185106314000316/v4_201501250140/en/main.assets"
  ]
  "en" => array:18 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Non-invasive parameters as predictors of high risk of variceal bleeding in cirrhotic patients"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "179"
        "paginaFinal" => "184"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "María Andrea Peñaloza-Posada, Eduardo Pérez-Torres, José Luis Pérez-Hernández, Fátima Higuera-de la Tijera"
        "autores" => array:4 [
          0 => array:2 [
            "nombre" => "María Andrea"
            "apellidos" => "Peñaloza-Posada"
          ]
          1 => array:2 [
            "nombre" => "Eduardo"
            "apellidos" => "Pérez-Torres"
          ]
          2 => array:2 [
            "nombre" => "José Luis"
            "apellidos" => "Pérez-Hernández"
          ]
          3 => array:4 [
            "nombre" => "Fátima"
            "apellidos" => "Higuera-de la Tijera"
            "email" => array:1 [
              0 => "fatimahiguera@hotmail.com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Gastroenterology Department, Hospital General de México &#8220;Dr. Eduardo Liceaga&#8221;, Mexico City"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author. Gastroenterology Department, <span class="elsevierStyleItalic">Hospital General de M&eacute;xico &#8220;Dr. Eduardo Liceaga&#8221;</span>, Dr. Balmis 148 Col. Doctores, 06726, Mexico City."
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Parámetros no invasivos como predictores de alto riesgo de hemorragia variceal en pacientes cirróticos"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Portal hypertension is a progressive complication of cirrhosis. Portal hypertension leads to the formation of porto-systemic collaterals. Gastroesophageal varices are the most relevant porto-systemic collaterals because their rupture results in variceal bleeding (VB), the most common lethal complication of cirrhosis, associated with a mortality of at least 20% at 6 weeks.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The most important predictor of variceal bleeding is the variceal size, with the highest risk of first hemorrhage about 15% per year occurring in patients with large varices. Other predictors of hemorrhage are decompensated cirrhosis (Child B/C) and the endoscopic presence of red wale marks.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Nowadays, the gold standard for assessing portal pressure is the hepatic venous pressure gradient (HVPG), which is obtained by determining the wedged hepatic venous pressure (WHVP) by placing a catheter in the hepatic vein and by inflating a balloon and occluding a larger branch of the hepatic vein, then the WHVP is corrected for increases in intraabdominal pressure by subtracting the free hepatic vein pressure (FHVP) or the intraabdominal inferior vena cava pressure.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The HVPG have predictive value for the development of gastroesophageal varices,<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> and the risk of VB.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;11</span></a> Patients with an HVPG &#8805; 20<span class="elsevierStyleHsp" style=""></span>mmHg (measured within 24<span class="elsevierStyleHsp" style=""></span>hours of VB) have been identified as being at a higher risk for early recurrent bleeding within the first week of admission or failure to control bleeding and a higher 1-year mortality compared to those with lower pressure.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,13</span></a> Late rebleeding occurs in approximately 60% of untreated patients, mostly within 1-2 years of the index hemorrhage.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15</span></a> Limitations to the generalized use of HVPG measurement are the lack of local expertise and poor adherence to guidelines that will ensure reliable and reproducible measurements,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> as well as its invasive nature.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Furthermore, is expensive and not always is available. For this reason, is very important to search for non-invasive, accessible, easy to perform, and reproducible parameters that can help us to identify patients with high risk of bleeding.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Many studies have evaluated non-invasive methods such as, low platelet count, spleen size, portal vein diameter, platelet count/spleen size ratio, and they seem to be predictors related to the presence of large or high grade esophageal varices.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#8211;32</span></a> However, there is not sufficient information about if these non-invasive parameters could be used as reliable predictors of high risk of VB that avoid the need for HVPG.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of this study was to evaluate if low platelet count, spleen size, platelet count/spleen size ratio, portal vein diameter, blood flow velocity of the portal vein, congestion index of the portal vein, and variceal size could be useful as non-invasive parameters for predicting a high risk of VB in cirrhotic patients.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Subjects and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Study design</span><p id="par0035" class="elsevierStylePara elsevierViewall">Observational, cross sectional study conducted since February 2011 to February 2013, including cirrhotic patients for any etiology, with portal hypertension and presence of esophageal varices documented by an endoscopic study. Patients with portal hypertension with a prehepatic or posthepatic origin, previous therapy with transjugular intrahepatic porto-systemic shunts, or with history of chirurgic derivation of the portal vein, spleenectomy, thrombosis or cavernomatosis of the portal vein, or with diagnosis of hepatocarcinoma were excluded.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Esophageal varices were classified according to Baveno V Consensus<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> in small or large varices. We searched for presence or absence of VB. Also patients must have a hepatic doppler ultrasound and laboratory tests to determine Child-Pugh score, and also platelet count, these studies must have been performed with no more than three months of difference regarding to the endoscopic study. Hepatic doppler ultrasound was performed with a Siemens Acuson S2000 equipment with a convex multi-frequency transductor by an expert radiologist, the following measures were performed: Portal vein diameter, blood flow velocity of the portal vein, spleen size (spleen longitudinal axis in centimeters), and with these parameters, were calculated the congestion index of the portal vein, and platelet count/spleen size ratio according to the next formulas:</p><p id="par0045" class="elsevierStylePara elsevierViewall">Congestion index of the portal vein<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>cross-sectional area of the portal vein (cm<span class="elsevierStyleSup">2</span>)/blood flow velocity of the portal vein (cm/sec)</p><p id="par0055" class="elsevierStylePara elsevierViewall">Platelet count/spleen size ratio<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>platelet count (cell/10<span class="elsevierStyleSup">3</span>)/spleen size (mm)</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">The distribution of numerical variables were analyzed with Kolmogorov-Smirnov test, in case of non-normal distribution, logarithmic base 10 transformation was performed to allowed expressed the variables as mean and standard deviation (SD). Qualitative variables were expressed as proportion and percentage. For predictive analysis we considered as the dependent variable &#8220;presence of VB&#8221; and the independent variables we tested were: Child-Pugh score, platelet count, spleen size, portal vein diameter, platelet count/spleen size ratio, blood flow velocity of the portal vein, congestion index of the portal vein, variceal size. Univariate and multivariate logistic regression were performed. A <span class="elsevierStyleItalic">P</span> value &#8804; 0.05 was considered significant. SPSS version 19.0 was employed.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">We included 99 cirrhotic patients with esophageal varices evidenced by endoscopic study, 56 (56.6%) were female, and 43 (43.4%) were male. The mean of age was 57.8<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>12.2. According to Child-Pugh score, 46 (46.5%) were Child-Pugh A, 41 (41.4%) were Child-Pugh B and 12 (12.1%) were Child-Pugh C. Chronic alcohol intake was the most common cause of cirrhosis counting for 43 (43.4%) patients, followed by non-alcoholic steatohepatitis in 20 (20.2%) patients, 16 (16.2%) patients with chronic viral hepatitis, 14 (14.1%) patients with cryptogenic cirrhosis, and 6 (6.1%)patients with an autoimmune origin. About variceal size, 54 (54.5%) of patients had large varices and 45 (45.5%) had small varices. Regarding to occurrence of VB, 46 (46.5%) presented it, and 53 (53.5%) did not.</p><p id="par0075" class="elsevierStylePara elsevierViewall">When we compared the characteristics between cirrhotic patients with VB and patients without VB, we found differences between groups regarding to spleen size, portal diameter, platelet count/spleen size ratio, congestion index of the portal vein, and variceal size (see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). However, in the multivariate analysis, the presence of large varices in the endoscopic study was the best predictor of VB (OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>11.1; 95% CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3.9 to 32.8, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0.0001) (see <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">When we evaluated non-invasive parameters: Child-Pugh score, platelet count/spleen size ratio, spleen size, portal vein diameter, portal vein congestion index, as predictive factors of the presence of large esophageal varices, we found that all of them, with exception of Child-Pugh score were predictive factors for the presence of large esophageal varices. The best predictive factor for presence of large esophageal varices was platelet count/spleen size ratio &#8804; 909 (OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2.2; 95% CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.3 to 1.8, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.003) (see <a class="elsevierStyleCrossRefs" href="#tbl0015">Tables 3 and 4</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">VB is one of the most serious complications of the portal hypertension in cirrhotic patients.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> To assess the degree of portal hypertension in patients with cirrhosis, the gold standard is the measurement of HVPG.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,6</span></a> Gastroesophageal varices develops in patients with a HVPG &#62; 10<span class="elsevierStyleHsp" style=""></span>mmHg, those with an HVPG &#62; 12<span class="elsevierStyleHsp" style=""></span>mmHg are at risk of VB, and those with an HVPG &#62; 20<span class="elsevierStyleHsp" style=""></span>mmHg are at high risk of rebleeding in the first 24<span class="elsevierStyleHsp" style=""></span>hours after a first episode of hemorrhage.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;13</span></a> According to several studies,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5,7,30&#8211;33</span></a> variceal size is one of the most important predictive risk factors for VB. In our study, we corroborate that the presence of large esophageal varices is the main independent predictive risk factor for VB in cirrhotic patients, despite of the class of Child-Pugh. However, is important to note that in our study most of patients were classified as Child-Pugh A and B, only a few patients were classified as Child-Pugh C. Other studies have found that Child-Pugh B/C patients have the greatest risk for develop large esophageal varices and VB.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,34,35</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Several previous studies have shown independent parameters like splenomegaly,<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34,36&#8211;39</span></a> low platelet count,<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34,37&#8211;39</span></a> portal vein diameter, <a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34,40</span></a> platelet count/spleen diameter ratio,<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34,41,42</span></a> congestion index of the portal vein <a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> as significant predictors for the presence of esophageal varices. In our study, we also found that spleen size, platelet count/spleen size ratio, portal vein diameter, spleen size and congestion index of the portal vein were independent predictors for the presence of large esophageal varices (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01), low platelet count was also found in patients with large esophageal varices (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.04). However, when we evaluated these non-invasive parameters as predictors of high risk of VB, only the portal vein diameter &#8805; 13<span class="elsevierStyleHsp" style=""></span>mm was a predictive factor (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.03) according to our multivariate analysis.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Primary prophylaxis to prevent the first VB is indicated in cirrhotic patients with large varices, either non-selective beta-blockers (NSBB) or endoscopic variceal ligation (EBL) can be used.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> The advantages of NSBB are that their cost is low, expertise is not required for their use, and they may prevent other complications, such as bleeding from portal hypertensive gastropathy, ascites, and spontaneous bacterial peritonitis because they reduce portal pressure. Additionally, many patients prefer to avoid endoscopic procedures because of their invasive nature.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> Since our study corroborates that non-invasive ultrasonographic parameters are capable to identify patients with large varices, and large varices are a main risk factor for VB, we propose that in selected patients, or when endoscopy is not available, non-invasive ultrasonographic parameters could be enough to decide start primary prophylaxis with NSBB.</p><p id="par0100" class="elsevierStylePara elsevierViewall">A limitation of our study is its retrolective character. Furthermore, in our institution we do not count with equipment to perform HPVG, therefore we could not determine it in our patients, as we did not count with the gold standard to prognosis the risk of VB we considered inappropriate to determine the sensibility, specificity, and predictive values for variceal size and portal vein diameter as tools for predict high risk of VB in cirrhotic patients.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Prospective studies to evaluate the non-invasive parameters proposed in this study are necessary to validate our findings. Since we collected the ultrasonographic data from medical records, we had not the opportunity to evaluate the inter-observer concordance.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusions</span><p id="par0110" class="elsevierStylePara elsevierViewall">The presence of large esophageal varices is the most important predictive risk factor for the occurrence of VB, independently of the class of Child-Pugh. Additionally, the portal vein diameter &#8805; 13<span class="elsevierStyleHsp" style=""></span>mm is a non-invasive parameter related to high risk of VB. Therefore, presence of large varices and a portal vein diameter &#8805; 13<span class="elsevierStyleHsp" style=""></span>mm can be used as predictors of high risk of VB when the measure of HPVG is not available. However, other non-invasive parameters seem to be not useful and cannot replace the determination of the HPVG.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Our study confirms that in medical centers where endoscopic study is not available, non-invasive parameters such as, portal vein diameter &#8805; 13<span class="elsevierStyleHsp" style=""></span>mm, spleen size &#8805; 13.5<span class="elsevierStyleHsp" style=""></span>cm, platelet count/spleen size &#8804; 909, and the portal vein congestion index &#62; 0.135 could be useful tools to predict the presence of large esophageal varices in cirrhotic patients independently of the class of Child-Pugh. The most useful of them, is platelet count/spleen size ratio. Therefore, these parameters could guide the decision to start primary prophylaxis.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflict of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">All authors declare have not conflict of interest.</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:2 [
          "identificador" => "xres414094"
          "titulo" => array:6 [
            0 => "Abstract"
            1 => "Introduction"
            2 => "Objective"
            3 => "Subjects and methods"
            4 => "Results"
            5 => "Conclusions"
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec389748"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xres414095"
          "titulo" => array:6 [
            0 => "Resumen"
            1 => "Introducci&oacute;n"
            2 => "Objetivo"
            3 => "Sujetos y m&eacute;todos"
            4 => "Resultados"
            5 => "Conclusiones"
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec389749"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Subjects and methods"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Study design"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Conclusions"
        ]
        9 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Conflict of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-08-14"
    "fechaAceptado" => "2014-09-03"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec389748"
          "palabras" => array:4 [
            0 => "Non-invasive parameters"
            1 => "Predictive factors"
            2 => "Variceal bleeding"
            3 => "Cirrhosis"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec389749"
          "palabras" => array:4 [
            0 => "Parámetros no invasivos"
            1 => "Factores predictivos"
            2 => "Hemorragia variceal"
            3 => "Cirrosis"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Variceal bleeding (VB) is a serious complication in cirrhotic patients. Hepatic pressure venous gradient (HPVG) is the gold standard to assess high risk of VB, but, this is not always available and is an invasive method. Therefore is necessary to explore if non-invasive parameters are useful as predictive factors of high risk of VB.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To evaluate if low platelet count, spleen size, platelet count/spleen size ratio, portal vein diameter, blood flow velocity of the portal vein, congestion index of the portal vein, and variceal size could be useful as non-invasive parameters for predicting high risk of VB in cirrhotic patients.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Subjects and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Observational, cross sectional study, that includes 99 cirrhotic patients with esophageal varices. For predictive analysis we considered as the dependent variable &#8220;presence of VB&#8221; and the independent variables we tested were: Child-Pugh score, platelet count, spleen size, portal vein diameter, platelet count/spleen size ratio, blood flow velocity of the portal vein, congestion index of the portal vein, variceal size. Univariate and multivariate logistic regression were performed.</p> <span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">99 cirrhotics with esophageal varices were included, 56 (56.6%) were female, the mean of age was 57.8<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>12.2. About variceal size, 54 (54.5%) of patients had large varices. Regarding to occurrence of VB, 46 (46.5%) presented it. In the multivariate analysis, the presence of large varices in the endoscopic study was the best predictor of VB (OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>11.1; 95% CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3.9 to 32.8, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0.0001). Portal vein diameter &#8805; 13<span class="elsevierStyleHsp" style=""></span>mm results with an OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5.0; 95% CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.1 to 21.7, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.03</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The presence of large esophageal varices is the most important predictive risk factor for the occurrence of VB, independently of the class of Child-Pugh. Additionally, the portal vein diameter &#8805; 13<span class="elsevierStyleHsp" style=""></span>mm is a non-invasive parameter related to high risk of VB. Therefore, these factors could be used as predictors of high risk of VB when the measure of HPVG is not available.</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Introducci&oacute;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La hemorragia variceal (HV) es una complicaci&oacute;n grave en pacientes cirr&oacute;ticos. El gradiente de presi&oacute;n venosa hep&aacute;tica (GPVH) es el est&aacute;ndar de oro para clasificar pacientes con alto riesgo de HV, sin embargo, este no siempre est&aacute; disponible y es un m&eacute;todo invasivo. Por tanto, es necesario explorar si par&aacute;metros no invasivos son &uacute;tiles como factores predictores de alto riesgo de HV.</p> <span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Evaluar si la baja cuenta plaquetaria, tama&ntilde;o del bazo, cociente cuenta plaquetaria/tama&ntilde;o del bazo, di&aacute;metro portal, velocidad del flujo portal, &iacute;ndice de congesti&oacute;n portal, y tama&ntilde;o variceal podr&iacute;an ser &uacute;tiles como par&aacute;metros no invasivos para predecir alto riesgo de HV en pacientes cirr&oacute;ticos.</p> <span class="elsevierStyleSectionTitle" id="sect0050">Sujetos y m&eacute;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional, transversal, que incluy&oacute; 99 pacientes cirr&oacute;ticos con varices esof&aacute;gicas. Para el an&aacute;lisis predictivo consideramos como la variable dependiente &#8220;presencia de HV&#8221;, y como variables independientes: estadio de Child-Pugh, cuenta plaquetaria, tama&ntilde;o del bazo, di&aacute;metro portal, cociente cuenta plaquetaria/tama&ntilde;o del bazo, velocidad del flujo portal, &iacute;ndice de congesti&oacute;n portal, tama&ntilde;o variceal. Realizamos an&aacute;lisis de regresi&oacute;n log&iacute;stica uni y multivariado.</p> <span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 99 pacientes cirr&oacute;ticos con varices esof&aacute;gicas, 56 (56.6%) fueron mujeres, la media de edad fue 57.8<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>12.2. Respecto al tama&ntilde;o variceal, 54 (54.5%) tuvieron varices grandes. Respecto a la ocurrencia de HV, 46 (46.5%) la presentaron. En el an&aacute;lisis multivariado, la presencia de varices grandes por endoscopia fue el mejor predictor de HV (RM<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>11.1; IC 95%<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3.9 a 32.8, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0.0001). El di&aacute;metro portal result&oacute; con una RM<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5.0; IC 95%<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.1 to 21.7, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.03.</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La presencia de varices esof&aacute;gicas grandes es el factor predictivo m&aacute;s importante de la ocurrencia de HV, independiente de la clase de Child-Pugh. Adicionalmente, el di&aacute;metro portal &#8805; 13<span class="elsevierStyleHsp" style=""></span>mm es un par&aacute;metro no invasivo relacionado con alto riesgo de HV. Por tanto, estos factores podr&iacute;an ser utilizados como predictores de alto riesgo de HV cuando en GPVH no este disponible.</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Qualitative variables are expressed as frequency and percent. Numerical variables are expressed as mean and standard deviation.</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cirrhotic patients with variceal bleedingn<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cirrhotic patients without variceal bleedingn<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top">Child-Pugh</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 (45.6)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 (47.1)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 (41.3)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 (41.6)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 (13.1)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 (11.3)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Platelet count (cell/10<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">104.1<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>44.2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">120.7<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>72.6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Spleen size (cm)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13.6<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>2.6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12.4<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>2.9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0.04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Portal diameter (mm)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12.9<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>2.5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11.3<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>3.3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0.01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Platelet count/spleen size ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">820.5<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>445.4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1061.1<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>744.7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0.05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Blood flow velocity of the portal vein (cm/seg)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18.2<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>5.7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20.8<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>8.5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Congestion index of the portal vein&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.135<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>0.51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.109<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>0.60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0.02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Variceal size (Large)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 (38.4)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 (16.2)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0.0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab646288.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Univariate analysis comparing characteristics between cirrhotic patients with and without variceal bleeding.</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>Odds ratio.</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">95% CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>95% Confidence interval.</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR (95% CI)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Variceal size(Large)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11.1 (3.9 &#8211; 32.8)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0.0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Portal vein diameter(&#8805; 13 mm)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5.0 (1.1 &#8211; 21.7)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0.03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Spleen size (&#8805; 13.5 cm)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1.0 (0.9 &#8211; 1.3)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Platelet count/spleen size ratio (&#8804; 909)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1.0 (0.9 &#8211; 1.0)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Congestion index of the portal vein (&#62; 0.135)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.0 (0.0 &#8211; 0.2)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab646287.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Multivariate analysis to determine predictive non-invasive parameters for high risk of variceal bleeding.</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Qualitative variables are expressed as frequency and percent. Numerical variables are expressed as mean and standard deviation.</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cirrhotic patients with large esophageal varices n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cirrhotic patients with small esophageal varices n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top">Child-Pugh</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 (37)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 (57.8)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 (50)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 (31.1)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 (13)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 (11.1)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Platelet count (cell/10<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">101.2<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>52.0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">127.1<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>69.0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0.04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Spleen size (cm)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13.6<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>2.9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12.2<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>2.4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0.01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Portal diameter (mm)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12.8<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>3.0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11.2<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>3.0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0.01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Platelet count/spleen size ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">802.2<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>500.7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1125.8<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>728.2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0.01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Blood flow velocity of the portal vein (cm/sec)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18.4<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>7.5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21.0<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>7.2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Congestion index of the portal vein&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.135<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>0.6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.105<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>0.5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0.01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab646286.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Univariate analysis comparing characteristics between cirrhotic patients with large and with small esophageal varices.</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>Odds ratio; 95% CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>95% confidence interval.</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Small varices n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>45 (%)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Large varices n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>54 (%)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR (95% CI)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Platelet count/spleen size ratio (&#8804;909)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 (46)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41 (75)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2.2 (1.3 a 3.8)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Spleen size (&#8805; 13.5cm)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 (31)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 (55)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1.6 (1.1 a 2.2)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Portal vein diameter (&#8805;13mm)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 (31)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 (53)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1.5 (1.1 a 2.1)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Congestion index of the portal vein (&#62;0.135)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 (28)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 (53)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0.01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1.5 (1.1 a 2.2)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab646289.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Multivariate analysis to identify predictive non-invasive parameters for presence of large esophageal varices in cirrhotic patients.</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:45 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Practice Guidelines Committee of the American Association for the Study of Liver Diseases and Practice Parameters Committee of American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G. Garcia-Tsao"
                            1 => "A.J. Sanyal"
                            2 => "N.D. Grace"
                            3 => "W. Carey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hep.21907"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2007"
                        "volumen" => "46"
                        "paginaInicial" => "922"
                        "paginaFinal" => "938"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17879356"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Improved survival after variceal hemorrhage over an 11-year period in the Department of Veterans Affairs"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H.B. El-Serag"
                            1 => "J.E. Everhart"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1572-0241.2000.03376.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2000"
                        "volumen" => "95"
                        "paginaInicial" => "3566"
                        "paginaFinal" => "3573"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11151893"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Upper digestive bleeding in cirrhosis Post-therapeutic outcome and prognostic indicators"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G. D&#8217;Amico"
                            1 => "R. de Franchis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/jhep.2003.50385"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2003"
                        "volumen" => "38"
                        "paginaInicial" => "599"
                        "paginaFinal" => "612"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12939586"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Improved survival after variceal bleeding in patients with cirrhosis over the past two decades"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N. Carbonell"
                            1 => "A. Pauwels"
                            2 => "L. Serfaty"
                            3 => "O. Fourdan"
                            4 => "V.G. Levy"
                            5 => "R. Poupon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hep.20339"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2004"
                        "volumen" => "40"
                        "paginaInicial" => "652"
                        "paginaFinal" => "659"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15349904"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "The North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM198810133191505"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1988"
                        "volumen" => "319"
                        "paginaInicial" => "983"
                        "paginaFinal" => "989"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3262200"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The hepatic venous pressure gradient: Anything worth doing should be done right"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R.J. Groszmann"
                            1 => "S. Wongcharatrawee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hep.20062"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2004"
                        "volumen" => "39"
                        "paginaInicial" => "280"
                        "paginaFinal" => "283"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14767976"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Portal pressure, presence of gastroesophageal varices and variceal bleeding"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "G. Garcia-Tsao"
                            1 => "R.J. Groszmann"
                            2 => "R.L. Fisher"
                            3 => "H.O. Conn"
                            4 => "C.E. Atterbury"
                            5 => "M. Glickman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "1985"
                        "volumen" => "5"
                        "paginaInicial" => "419"
                        "paginaFinal" => "424"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3873388"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "for the Portal Hypertension Collaborative Group Betablockers to prevent gastroesophageal varices in patients with cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R.J. Groszmann"
                            1 => "G. Garcia-Tsao"
                            2 => "J. Bosch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa044456"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2005"
                        "volumen" => "353"
                        "paginaInicial" => "2254"
                        "paginaFinal" => "2261"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16306522"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hemodynamic events in a prospective randomized trial of propranolol vs placebo in the prevention of the first variceal hemorrhage"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R.J. Groszmann"
                            1 => "J. Bosch"
                            2 => "N. Grace"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "1990"
                        "volumen" => "99"
                        "paginaInicial" => "1401"
                        "paginaFinal" => "1407"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2210246"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relation between portal pressure response to pharmacotherapy and risk of recurrent variceal haemorrhage in patients with cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F. Feu"
                            1 => "J.C. Garcia-Pagan"
                            2 => "J. Bosch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "1995"
                        "volumen" => "346"
                        "paginaInicial" => "1056"
                        "paginaFinal" => "1059"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7564785"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S001650850702032X"
                          "estado" => "S300"
                          "issn" => "00165085"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "HVPG reduction and prevention of variceal bleeding in cirrhosis. A systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G. D&#8217;Amico"
                            1 => "J.C. Garcia-Pagan"
                            2 => "A. Luca"
                            3 => "J. Bosch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "2006"
                        "volumen" => "131"
                        "paginaInicial" => "1624"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic value of early measurements of portal pressure in acute variceal bleeding"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E. Moitinho"
                            1 => "A. Escorsell"
                            2 => "J.C. Bandi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "1999"
                        "volumen" => "117"
                        "paginaInicial" => "626"
                        "paginaFinal" => "631"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10464138"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Influence of portal hypertension and its early decompression by TIPS placement on the outcome of variceal bleeding"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A. Monescillo"
                            1 => "F. Martinez-Lagares"
                            2 => "L. Ruiz del Arbol"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hep.20386"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2004"
                        "volumen" => "40"
                        "paginaInicial" => "793"
                        "paginaFinal" => "801"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15382120"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pharmacological treatment of portal hypertension: an evidence-based approach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G. D&#8217;Amico"
                            1 => "L. Pagliaro"
                            2 => "J. Bosch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-2007-1007133"
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Liver Dis"
                        "fecha" => "1999"
                        "volumen" => "19"
                        "paginaInicial" => "475"
                        "paginaFinal" => "505"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10643630"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevention of variceal rebleeding"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J. Bosch"
                            1 => "J.C. Garcia-Pagan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(03)12778-X"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2003"
                        "volumen" => "361"
                        "paginaInicial" => "952"
                        "paginaFinal" => "954"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12648985"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence and predictors of esophageal varices in patients with primary sclerosing cholangitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C.O. Zein"
                            1 => "K.D. Lindor"
                            2 => "P. Angulo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hep.20029"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2004"
                        "volumen" => "39"
                        "paginaInicial" => "204"
                        "paginaFinal" => "210"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14752839"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Application of the platelet count/spleen diameter ratio to rule out the presence of oesophageal varices in patients with cirrhosis: a validation study based on follow-up"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E.G. Giannini"
                            1 => "F. Botta"
                            2 => "P. Borro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.dld.2005.05.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dig Liver Dis"
                        "fecha" => "2005"
                        "volumen" => "37"
                        "paginaInicial" => "779"
                        "paginaFinal" => "785"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15996912"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices: results of a multicenter, prospective, validation study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E.G. Giannini"
                            1 => "A. Zaman"
                            2 => "A. Kreil"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1572-0241.2006.00874.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2006"
                        "volumen" => "101"
                        "paginaInicial" => "2511"
                        "paginaFinal" => "2519"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17029607"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prediction of large esophageal varices in patients with cirrhosis of the liver using clinical, laboratory and imaging parameters"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S.K. Sharma"
                            1 => "R. Aggarwal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1440-1746.2006.04501.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Gastroenterol Hepatol"
                        "fecha" => "2007"
                        "volumen" => "22"
                        "paginaInicial" => "1909"
                        "paginaFinal" => "1915"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17914969"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Platelet count is not a predictor of the presence or development of gastroesophageal varices in cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A.A. Qamar"
                            1 => "N.D. Grace"
                            2 => "R.J. Groszmann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hep.21941"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2008"
                        "volumen" => "47"
                        "paginaInicial" => "153"
                        "paginaFinal" => "159"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18161700"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Platelet count/spleen diameter ratio for non-invasive prediction of high risk esophageal varices in cirrhotic patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F. Barrera"
                            1 => "A. Riquelme"
                            2 => "A. Soza"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Hepatol"
                        "fecha" => "2009"
                        "volumen" => "8"
                        "paginaInicial" => "325"
                        "paginaFinal" => "330"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20009131"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The predictors of the presence of varices in patients with primary sclerosing cholangitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S. Treeprasertsuk"
                            1 => "K.V. Kowdley"
                            2 => "V.A. Luketic"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hep.23432"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2010"
                        "volumen" => "51"
                        "paginaInicial" => "1302"
                        "paginaFinal" => "1310"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20044810"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Utilization of platelet count spleen diameter ratio in predicting the presence of esophageal varices in patients with cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E. Schwarzenberger"
                            1 => "T. Meyer"
                            2 => "V. Golla"
                            3 => "N.P. Sahdala"
                            4 => "A.D. Min"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MCG.0b013e3181a745ff"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Gastroenterol"
                        "fecha" => "2010"
                        "volumen" => "44"
                        "paginaInicial" => "146"
                        "paginaFinal" => "150"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19593164"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Noninvasive prediction of large esophageal varices in chronic liver disease patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A. Sarangapani"
                            1 => "C. Shanmugam"
                            2 => "M. Kalyanasundaram"
                            3 => "B. Rangachari"
                            4 => "P. Thangavelu"
                            5 => "J.K. Subbarayan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/1319-3767.58767"
                      "Revista" => array:6 [
                        "tituloSerie" => "Saudi J Gastroenterol"
                        "fecha" => "2010"
                        "volumen" => "16"
                        "paginaInicial" => "38"
                        "paginaFinal" => "42"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20065573"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prediction of esophageal varices in hepatic cirrhosis by noninvasive markers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J.R. Tafarel"
                            1 => "L.H. Tolentino"
                            2 => "L.M. Correa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MEG.0b013e3283488a88"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Gastroenterol Hepatol"
                        "fecha" => "2011"
                        "volumen" => "23"
                        "paginaInicial" => "754"
                        "paginaFinal" => "758"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21691209"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence, prevalence, and clinical significance of abnormal hematologic indices in compensated cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A.A. Qamar"
                            1 => "N.D. Grace"
                            2 => "R.J. Groszmann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cgh.2009.02.021"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Gastroenterol Hepatol"
                        "fecha" => "2009"
                        "volumen" => "7"
                        "paginaInicial" => "689"
                        "paginaFinal" => "695"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19281860"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Platelet count/spleen diameter ratio to predict the presence of esophageal varices in patients with cirrhosis: a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S. Chawla"
                            1 => "A. Katz"
                            2 => "B.M. Attar"
                            3 => "A. Gupta"
                            4 => "D.S. Sandhu"
                            5 => "R. Agarwal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MEG.0b013e3283505015"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Gastroenterol Hepatol"
                        "fecha" => "2012"
                        "volumen" => "24"
                        "paginaInicial" => "431"
                        "paginaFinal" => "436"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22410714"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Non-invasive model predicting clinically-significant portal hypertension in patients with advanced fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S.H. Park"
                            1 => "T.E. Park"
                            2 => "Y.M. Kim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1440-1746.2009.05904.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Gastroenterol Hepatol"
                        "fecha" => "2009"
                        "volumen" => "24"
                        "paginaInicial" => "1289"
                        "paginaFinal" => "1293"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19682196"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Derivation of a clinical prediction rule for the noninvasive diagnosis of varices in children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J.C. Gana"
                            1 => "D. Turner"
                            2 => "E.A. Roberts"
                            3 => "S.C. Ling"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MPG.0b013e3181b64437"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Gastroenterol Nutr"
                        "fecha" => "2010"
                        "volumen" => "50"
                        "paginaInicial" => "188"
                        "paginaFinal" => "193"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19966576"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management and Treatment of Patients With Cirrhosis and Portal Hypertension: Recomendations From the Department of Veterans Affairs Hepatiis C Resource Center Program and the National Hepatitis C Program"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G. Garc&iacute;a-Tsao"
                            1 => "J. Lim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ajg.2009.191"
                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2009"
                        "volumen" => "104"
                        "paginaInicial" => "1802"
                        "paginaFinal" => "1829"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19455106"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S001650850800913X"
                          "estado" => "S300"
                          "issn" => "00165085"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessing portal hypertension in liver diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A. Berzigotti"
                            1 => "S. Seijo"
                            2 => "E. Reverter"
                            3 => "J. Bosch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1586/egh.12.83"
                      "Revista" => array:6 [
                        "tituloSerie" => "Expert Rev Gastroenterol Hepatol"
                        "fecha" => "2013"
                        "volumen" => "7"
                        "paginaInicial" => "141"
                        "paginaFinal" => "155"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23363263"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pathophysiology of portal Hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J. Bosch"
                            1 => "P. Pizcueta"
                            2 => "F. Feu"
                            3 => "M. Fernandez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterol Clin North Am."
                        "fecha" => "1992"
                        "volumen" => "21"
                        "paginaInicial" => "1"
                        "paginaFinal" => "14"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1568770"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Revising consensus in portal hypertension: Report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R. De Franchis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jhep.2010.06.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hepatol"
                        "fecha" => "2010"
                        "volumen" => "53"
                        "paginaInicial" => "762"
                        "paginaFinal" => "768"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20638742"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Non-invasive predictors of esophageal varices"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J.V. Cherian"
                            1 => "N. Deepak"
                            2 => "R.P. Ponnusamy"
                            3 => "A. Somasundaram"
                            4 => "V. Jayanthi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/1319-3767.74470"
                      "Revista" => array:6 [
                        "tituloSerie" => "Saudi J Gastroenterol"
                        "fecha" => "2011"
                        "volumen" => "17"
                        "paginaInicial" => "64"
                        "paginaFinal" => "68"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21196656"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors for the presence of varices in cirrhotic patients without a history of variceal hemorrhage"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A. Zaman"
                            1 => "T. Becker"
                            2 => "J. Lapidus"
                            3 => "K. Benner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Intern Med"
                        "fecha" => "2001"
                        "volumen" => "161"
                        "paginaInicial" => "2564"
                        "paginaFinal" => "2570"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11718587"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Correlation between splenomegaly and oesophageal varices in patients with liver cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D.N. Amarapurkar"
                            1 => "S.S. Parikh"
                            2 => "K. Shankaran"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-2007-1009036"
                      "Revista" => array:6 [
                        "tituloSerie" => "Endoscopy."
                        "fecha" => "1994"
                        "volumen" => "26"
                        "paginaInicial" => "563"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7828573"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0016508511001387"
                          "estado" => "S300"
                          "issn" => "00165085"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of large esophageal varices in patients with cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "N. Chalasani"
                            1 => "T.F. Imperiale"
                            2 => "A. Ismail"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1572-0241.1999.1539_a.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol."
                        "fecha" => "1999"
                        "volumen" => "94"
                        "paginaInicial" => "3285"
                        "paginaFinal" => "3291"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10566731"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prediction of esophageal varices in patients with cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R. Madhotra"
                            1 => "H.E. Mulcahy"
                            2 => "I. Willner"
                            3 => "A. Reuben"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Gastroenterol."
                        "fecha" => "2002"
                        "volumen" => "34"
                        "paginaInicial" => "81"
                        "paginaFinal" => "85"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11743252"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Non-invasive predictors of the presence of large oesophageal varices in patients with cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K.C. Thomopoulos"
                            1 => "C. Labropoulou-Karatza"
                            2 => "K.P. Mimidis"
                            3 => "E.C. Katsakoulis"
                            4 => "G. Iconomou"
                            5 => "V.N. Nikolopoulou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Dig Liver Dis."
                        "fecha" => "2003"
                        "volumen" => "35"
                        "paginaInicial" => "473"
                        "paginaFinal" => "478"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12870732"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection?"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F. Schepis"
                            1 => "C. Camma"
                            2 => "D. Niceforo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/jhep.2001.21410"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology."
                        "fecha" => "2001"
                        "volumen" => "33"
                        "paginaInicial" => "333"
                        "paginaFinal" => "338"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11172334"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Platelet count/spleen diameter ratio: Proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E. Giannini"
                            1 => "F. Botta"
                            2 => "P. Borro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gut."
                        "fecha" => "2003"
                        "volumen" => "52"
                        "paginaInicial" => "1200"
                        "paginaFinal" => "1205"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12865282"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices: Results of a multicenter, prospective, validation study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E. Giannini"
                            1 => "A. Zaman"
                            2 => "A. Kreil"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1572-0241.2006.00874.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol."
                        "fecha" => "2006"
                        "volumen" => "101"
                        "paginaInicial" => "2511"
                        "paginaFinal" => "2519"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17029607"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Congestion Index of the Portal vein"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F. Moriyasu"
                            1 => "O. Nishida"
                            2 => "N. Ban"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "American Roentgen Ray Society"
                        "fecha" => "1986"
                        "volumen" => "12"
                        "paginaInicial" => "735"
                        "paginaFinal" => "739"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Banding ligation versus betablockers as primary prophylaxis in esophageal varices: systematic review of randomized trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L.L. Gluud"
                            1 => "S. Klingenberg"
                            2 => "D. Nikolova"
                            3 => "C. Gluud"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1572-0241.2007.01564.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2007"
                        "volumen" => "102"
                        "paginaInicial" => "2842"
                        "paginaFinal" => "2848"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18042114"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of varices and variceal hemorrhage in cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G. Garc&iacute;a-Tsao"
                            1 => "J. Bosch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMra0901512"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2010"
                        "volumen" => "362"
                        "paginaInicial" => "823"
                        "paginaFinal" => "832"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20200386"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/01851063/0000007700000004/v4_201501250140/S0185106314000304/v4_201501250140/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "13821"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Art&#237;culos originales"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/01851063/0000007700000004/v4_201501250140/S0185106314000304/v4_201501250140/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0185106314000304?idApp=UINPBA00004N"
]

Article information

ISSN: 01851063
Original language: English

DOI:10.1016/j.hgmx.2014.09.002

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	3	0	3
2024 October	40	7	47
2024 September	61	16	77
2024 August	72	10	82
2024 July	75	2	77
2024 June	75	11	86
2024 May	83	5	88
2024 April	95	4	99
2024 March	116	10	126
2024 February	74	10	84
2024 January	65	10	75
2023 December	32	4	36
2023 November	31	12	43
2023 October	19	5	24
2023 September	17	4	21
2023 August	10	3	13
2023 July	31	9	40
2023 June	9	5	14
2023 May	21	11	32
2023 April	8	3	11
2023 March	11	3	14
2023 February	21	5	26
2023 January	15	4	19
2022 December	15	7	22
2022 November	22	4	26
2022 October	16	6	22
2022 September	14	7	21
2022 August	10	7	17
2022 July	12	8	20
2022 June	8	5	13
2022 May	11	10	21
2022 April	10	10	20
2022 March	26	7	33
2022 February	21	5	26
2022 January	36	9	45
2021 December	38	8	46
2021 November	24	10	34
2021 October	29	9	38
2021 September	23	7	30
2021 August	18	10	28
2021 July	36	6	42
2021 June	18	10	28
2021 May	23	6	29
2021 April	40	4	44
2021 March	16	6	22
2021 February	13	6	19
2021 January	25	11	36
2020 December	23	6	29
2020 November	31	9	40
2020 October	20	10	30
2020 September	20	10	30
2020 August	28	7	35
2020 July	18	6	24
2020 June	31	5	36
2020 May	29	5	34
2020 April	26	6	32
2020 March	22	4	26
2020 February	34	8	42
2020 January	28	5	33
2019 December	20	7	27
2019 November	23	11	34
2019 October	39	6	45
2019 September	34	9	43
2019 August	39	7	46
2019 July	34	21	55
2019 June	57	15	72
2019 May	125	22	147
2019 April	46	18	64
2019 March	18	3	21
2019 February	16	12	28
2019 January	19	6	25
2018 December	14	10	24
2018 November	26	6	32
2018 October	15	13	28
2018 September	18	9	27
2018 August	17	4	21
2018 July	2	6	8
2018 June	9	9	18
2018 May	15	12	27
2018 April	5	8	13
2018 March	13	7	20
2018 February	7	4	11
2018 January	8	3	11
2017 December	12	5	17
2017 November	6	8	14
2017 October	22	13	35
2017 September	13	23	36
2017 August	18	18	36
2017 July	17	15	32
2017 June	34	30	64
2017 May	37	24	61
2017 April	18	24	42
2017 March	17	67	84
2017 February	22	24	46
2017 January	14	9	23
2016 December	55	10	65
2016 November	37	24	61
2016 October	63	33	96
2016 September	59	147	206
2016 August	26	17	43
2016 July	51	2	53
2016 June	35	20	55
2016 May	41	18	59
2016 April	28	18	46
2016 March	34	20	54
2016 February	47	22	69
2016 January	33	27	60
2015 December	46	19	65
2015 November	32	19	51
2015 October	51	36	87
2015 September	59	25	84
2015 August	29	29	58
2015 July	46	22	68
2015 June	32	23	55
2015 May	50	41	91
2015 April	53	46	99
2015 March	39	44	83
2015 February	62	35	97
2015 January	103	29	132
2014 December	10	8	18

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter