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Vol. 21.
(March - April 2021)
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Vol. 21.
(March - April 2021)
Letters to the Editor
DOI: 10.1016/j.aohep.2020.10.003
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New model predicting gastroesophageal varices and variceal hemorrhage in patients with chronic liver disease
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Yongxin Chen, Xiaofei Li
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icqwc46@163.com

Corresponding author.
Department of Infectious Diseases, YiWu Central Hospital, Zhejiang 322000, China
Related content
Ann Hepatol. 2021;21C:10.1016/j.aohep.2021.100313
Ling-ling He, Jia-li Ma, Yu Jiang, Jun-ru Yang, Ping Li, Yao Zhang, Hong-shan Wei
Received 15 September 2020
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Dear Editor,

Recently, we read with great interest the study by Ma JL et al. [1] who mainly assessed a new model for predicting gastroesophageal varices (GOV) and variceal hemorrhage (VH) in patients with chronic liver diseases (CLDs). The new algorithm developed in this study is novel and provides evidence for the prediction of GOV and VH in CLDs patients. The author's great efforts are praiseworthy, but the following issues need to be carefully considered.

First, it needs to be emphasized that MELD score and Child–Pugh score are important indicators for evaluating the severity of liver function in CLDs patients, which have been widely recognized worldwide [2,3]. In addition, the above two scores are also generally used in clinical practice. However, these two scores were not reported in this study. Therefore, we do not know the severity of liver function in CLDs patients included in this study. Considering that the above two scores are evaluated according to the results of routine examinations in clinical practice, it is necessary to describe the severity of patients included in this study.

Second, previous studies have indicated that obesity is closely related to the progression of chronic viral hepatitis [4]. Evidence from a cohort study in the UK suggested that approximately 17% of cirrhosis is caused by excessive weight gain [5]. In addition, the prognosis of patients with obesity related cirrhosis is worse than that of non-obese patients [6]. Accordingly, the progression of cirrhosis increases the risk of GOV or VH in CLDs patients. However, body weight or body mass index, two important indicators of nutritional status commonly used in clinical practice, was not reported in this study.

Third, it is generally accepted that portal hypertension is an important factor leading to GOV and VH in CLDs patients. Is hepatic venous pressure gradient (HVPG) different between GOV and No-GOV patients in this study [7,8]? Is HVPG associated with GOV in CLDs patients? Although this is a retrospective cohort study, and it may be difficult to report HVPG values, we believe that solving this issue will help clinicians better understand the conclusion of this study.

Declaration of funding interests

None.

Conflict of interest

The authors have no conflict of interest to declare.

References
[1]
J.L. Ma, L.L. He, Y. Jiang, J.R. Yang, P. Li, Y. Zang, et al.
New model predicting gastroesophageal varices and variceal hemorrhage in patients with chronic liver disease.
[2]
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Child–Pugh versus MELD score for the assessment of prognosis in liver cirrhosis: a systematic review and meta-analysis of observational studies.
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Child-Pugh, MELD, and ALBI scores for predicting the in-hospital mortality in cirrhotic patients with acute-on-chronic liver failure.
Exp Rev Gastroenterol Hepatol, 10 (2016), pp. 971-980
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Obesity is an independent risk factor for clinical decompensation in patients with cirrhosis.
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Body mass index and risk of liver cirrhosis in middle aged UK women: prospective study.
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R. Karagozian, G. Bhardwaj, D.B. Wakefield, G. Baffy.
Obesity paradox in advanced liver disease: obesity is associated with lower mortality in hospitalized patients with cirrhosis.
Liver Int, 36 (2016), pp. 1450-1456
[7]
E. Boleslawski, G. Petrovai, S. Truant, S. Dharancy, A. Duhamel, J. Salleron, et al.
Hepatic venous pressure gradient in the assessment of portal hypertension before liver resection in patients with cirrhosis.
Br J Surg, 99 (2012), pp. 855-863
[8]
N. Afdhal, G.T. Everson, J.L. Calleja, G.W. McCaughan, J. Bosch, D.M. Brainard, et al.
Effect of viral suppression on hepatic venous pressure gradient in hepatitis C with cirrhosis and portal hypertension.
J Viral Hepatitis, 24 (2017), pp. 823-831
Copyright © 2020. Fundación Clínica Médica Sur, A.C.
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