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Renovascular Impedance and Esophageal Varices in Patients with Child-Pugh Class A Cirrhosis¹

¹ From the Division of Medicine, Ospedale di Lecco, Italy (A.C., M.C.), and the Cattedra di Gastroenterologia, IRCCS Ospedale Maggiore, Via F Sforza 35, 20122 Milan, Italy (M.F., R.P., S.V., D.C.). Received May 22, 2000; revision requested July 2; final revision received October 2; accepted November 1. Supported by a research grant (1998–1999) from the CARIPLO Foundation and the Associazione Amici Gastroenterologia del Granelli, Milan, Italy. Address correspondence to D.C. (e-mail: dario.conte@unimi.it).

PURPOSE: To evaluate the frequency of increased renovascular impedance and its relationship with the presence of esophageal varices in patients with Child-Pugh class A cirrhosis without ascites.

MATERIALS AND METHODS: The intraparenchymal renal resistive index (RI) (reference value, <0.7) and portal congestive index (ie, the ratio between the portal cross-sectional area and mean flow velocity; reference value, <0.07) were measured by using duplex Doppler ultrasonography in 50 consecutive patients. The frequency of varices was assessed endoscopically. The data were analyzed with the Fisher exact test.

RESULTS: The renal RI was consistent with increased impedance (ie, >0.7) in 18 (36%) patients and was normal in 32 (64%). The proportion of patients with varices was significantly higher in the former group: 14 (78%) versus 10 (31%) (P = .002). In detection of the presence of varices, the renal RI was uniformly better than the portal congestive index in terms of sensitivity (58% vs 48%), specificity (84% vs 54%), and positive (3.60 vs 1.04) and negative (0.50 vs 0.96) likelihood ratios. RI determination improved the ability to exclude the presence of varices from a basal pretest probability of 52% (26 of 50 patients) to a final one of 69% (22 of 32 patients) and that of predicting the presence of varices from 48% (24 of 50 patients) to 78% (14 of 18 patients).

CONCLUSION: A substantial proportion of patients with Child-Pugh class A cirrhosis without ascites have increased renovascular impedance; this significantly correlates with the presence of varices.

Index terms: Endoscopy, 70.129, 70.75 • Esophagus, varices, 71.75 • Hypertension, portal, 76.794 • Kidney, perfusion, 81.72 • Liver, cirrhosis, 76.794 • Ultrasound (US), Doppler studies, 81.12984

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