Oesophageal varices bleeding prediction

Context

Cirrhosis in children happens and often stems from a wide variety of causes. Up to now, biliary atresia, after failed Kasai surgery, remains the leading cause of children cirrhosis and pediatric transplantation. While awaiting a transplant, cirrhotic patients, whatever the cause, run the risk of gastrointestinal (GI) bleeding due to portal hypertension. In cases of portal hypertension in children, it is established that bleeding risk is correlated with esophageal varices characteristics (Grade III varices; red color signs). While recommended in adults, prophylactic treatment remains controversial in children, despite being suggested by several authors. The procedure is indeed a delicate one and not devoid of complications. Moreover, living donor related liver transplantation, an increasingly common solution in recent years, has significantly reduced waiting times, leading to doubts about interest of prophylactic treatment.

Objective

Based on clinical and biological data, we had to establish a new score predictive of the bleeding of the children, validate it and develop a tool making the findings available to the medical community.

What we did

We developed an innovative multi-marker solution along with a predictive model to predict the bleeding risk in children. We started by designing the data analysis on a first patients cohort, then selected relevant markers and combined them into a predictive solution, that we evaluated on this same cohort through an adequate, bias-free protocol. We then prospectively validated the tool on a new, independent cohort and completely confirmed the results. They have been implemented in a web application now available on HRS2C2.com.

Several publications have also been produced and accepted.

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