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Prognostic indicators of risk for first variceal bleeding in cirrhosis: a multicenter study in 711 patients to validate and improve the North Italian Endoscopic Club (NIEC) index.
Am J Gastroenterol. 2000 Oct; 95(10):2915-20.AJ

Abstract

OBJECTIVE

The best known indicator of risk for first bleeding in patients with cirrhosis without previous bleeding is the index devised by the North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices (NIEC index), which results from the combination of size of esophageal varices, severity of red wale marks, and Child-Pugh class. Its efficiency is far from optimal, and validation studies have reported sensitivities and specificities markedly lower than those reported in the original study. In the present study we analyzed the efficiency of NIEC index in a large series of cirrhotic patients with varices without previous bleeding. In addition, we tried to improve the effectiveness of the index by modifying it, and to validate the modifications in an independent group of patients.

METHODS

A total of 627 patients were enrolled and followed until either a variceal bleeding or for a maximum of 2 yr. During this time, 117 experienced a first variceal

RESULTS

Using Cox's regression analysis, size of varices, severity of red wale marks, and Child-Pugh score were significant and independent predictors of first bleeding, as already noted in the original report of the NIEC group. However, coefficients and standard errors were markedly different, and the importance of size of esophageal varices in the regression was much larger, whereas that of Child-Pugh score was much lower. According to these data, a revised index was developed (Rev-NIEC). Using receiver operating characteristic (ROC) curve analysis, the revised index showed a larger efficiency, and the area under the curve was significantly larger (0.80 +/- 0.02 vs 0.74 +/- 0.02; p < 0.01). In particular, the curve showed that for a specificity of 75%, the new index had a sensitivity of 72% compared to that of 55% of the NIEC index. Validation in an independent sample of 84 patients showed good agreement between predicted and observed risk for bleeding. Validation with the bootstrap technique also showed adequate stability of the results.

CONCLUSIONS

The revised index seems to be superior to the traditional index, and may turn out to be more useful in the selection of patients for different therapeutic procedures and in the stratification of patients in clinical trials.

Authors+Show Affiliations

Department of Clinical and Experimental Medicine, University of Padua, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11051368

Citation

Merkel, C, et al. "Prognostic Indicators of Risk for First Variceal Bleeding in Cirrhosis: a Multicenter Study in 711 Patients to Validate and Improve the North Italian Endoscopic Club (NIEC) Index." The American Journal of Gastroenterology, vol. 95, no. 10, 2000, pp. 2915-20.
Merkel C, Zoli M, Siringo S, et al. Prognostic indicators of risk for first variceal bleeding in cirrhosis: a multicenter study in 711 patients to validate and improve the North Italian Endoscopic Club (NIEC) index. Am J Gastroenterol. 2000;95(10):2915-20.
Merkel, C., Zoli, M., Siringo, S., van Buuren, H., Magalotti, D., Angeli, P., Sacerdoti, D., Bolondi, L., & Gatta, A. (2000). Prognostic indicators of risk for first variceal bleeding in cirrhosis: a multicenter study in 711 patients to validate and improve the North Italian Endoscopic Club (NIEC) index. The American Journal of Gastroenterology, 95(10), 2915-20.
Merkel C, et al. Prognostic Indicators of Risk for First Variceal Bleeding in Cirrhosis: a Multicenter Study in 711 Patients to Validate and Improve the North Italian Endoscopic Club (NIEC) Index. Am J Gastroenterol. 2000;95(10):2915-20. PubMed PMID: 11051368.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic indicators of risk for first variceal bleeding in cirrhosis: a multicenter study in 711 patients to validate and improve the North Italian Endoscopic Club (NIEC) index. AU - Merkel,C, AU - Zoli,M, AU - Siringo,S, AU - van Buuren,H, AU - Magalotti,D, AU - Angeli,P, AU - Sacerdoti,D, AU - Bolondi,L, AU - Gatta,A, PY - 2000/10/29/pubmed PY - 2001/2/28/medline PY - 2000/10/29/entrez SP - 2915 EP - 20 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 95 IS - 10 N2 - OBJECTIVE: The best known indicator of risk for first bleeding in patients with cirrhosis without previous bleeding is the index devised by the North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices (NIEC index), which results from the combination of size of esophageal varices, severity of red wale marks, and Child-Pugh class. Its efficiency is far from optimal, and validation studies have reported sensitivities and specificities markedly lower than those reported in the original study. In the present study we analyzed the efficiency of NIEC index in a large series of cirrhotic patients with varices without previous bleeding. In addition, we tried to improve the effectiveness of the index by modifying it, and to validate the modifications in an independent group of patients. METHODS: A total of 627 patients were enrolled and followed until either a variceal bleeding or for a maximum of 2 yr. During this time, 117 experienced a first variceal RESULTS: Using Cox's regression analysis, size of varices, severity of red wale marks, and Child-Pugh score were significant and independent predictors of first bleeding, as already noted in the original report of the NIEC group. However, coefficients and standard errors were markedly different, and the importance of size of esophageal varices in the regression was much larger, whereas that of Child-Pugh score was much lower. According to these data, a revised index was developed (Rev-NIEC). Using receiver operating characteristic (ROC) curve analysis, the revised index showed a larger efficiency, and the area under the curve was significantly larger (0.80 +/- 0.02 vs 0.74 +/- 0.02; p < 0.01). In particular, the curve showed that for a specificity of 75%, the new index had a sensitivity of 72% compared to that of 55% of the NIEC index. Validation in an independent sample of 84 patients showed good agreement between predicted and observed risk for bleeding. Validation with the bootstrap technique also showed adequate stability of the results. CONCLUSIONS: The revised index seems to be superior to the traditional index, and may turn out to be more useful in the selection of patients for different therapeutic procedures and in the stratification of patients in clinical trials. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/11051368/Prognostic_indicators_of_risk_for_first_variceal_bleeding_in_cirrhosis:_a_multicenter_study_in_711_patients_to_validate_and_improve_the_North_Italian_Endoscopic_Club__NIEC__index_ L2 - https://doi.org/10.1111/j.1572-0241.2000.03204.x DB - PRIME DP - Unbound Medicine ER -