The North Italian Endoscopic Club (NIEC) has proposed an index for predicting hemorrhage from esophageal varices in patients with cirrhosis of the liver and esophageal varices.
Parameters for index:
(1) Child class, which is an index of liver dysfunction based on serum albumin concentration, bilirubin concentration, prothrombin time, and the presence of ascites and encephalopathy. It is described in this documentation with the liver diseases.
(2) size of varices, based on the Japanese Research Society for Portal Hypertension
(3) presence and nature of red wale markings, which are longitudinal dilated venules resembling whip marks on the varices
The index may be calculated either with:
(a) the Cox equation
(b) with a pocket chart
Calculation of Index with Cox Equation
|
Parameter |
Finding |
Points |
|---|---|---|
|
Child class |
A |
1 |
|
|
B |
2 |
|
|
C |
3 |
|
size of varices |
small |
2 |
|
|
medium |
3 |
|
|
large |
4 |
|
red wale markings |
absent |
1 |
|
|
mild |
2 |
|
|
moderate |
3 |
|
|
severe |
4 |
NIEC index =
= ((0.645 * (Child class points)) + (0.4365 * (size of varices points)) + (0.3193 * (red wale markings points))) * 10
where:
• 10 is multiplied to reduce the number of decimals
Pocket Chart for Easy Calculation of Index
A pocket chart is available, which simply multiplies out all of the variables above and stores them in the table.
|
Parameter |
Finding |
Points |
|---|---|---|
|
Child class |
A |
6.5 |
|
|
B |
13.0 |
|
|
C |
19.5 |
|
size of varices |
small |
8.7 |
|
|
medium |
13.0 |
|
|
large |
17.4 |
|
red wale markings |
absent |
3.2 |
|
|
mild |
6.4 |
|
|
moderate |
9.6 |
|
|
severe |
12.8 |
NIEC index =
= (points for Child class) + (points for size of varices) + (points for red wale markings)
Interpretation
|
Risk Class |
NIEC index |
% bleeding at 6 months |
% bleeding at 1 year |
% bleeding at 2 years |
|---|---|---|---|---|
|
1 |
< 20.0 |
0.0 |
1.6 |
6.8 |
|
2 |
20.0 - 25.0 |
5.4 |
11.0 |
16.0 |
|
3 |
25.1 - 30.0 |
8.0 |
14.8 |
25.5 |
|
4 |
30.1 - 35.0 |
13.1 |
23.3 |
27.8 |
|
5 |
35.1 - 40.0 |
21.8 |
37.8 |
58.8 |
|
6 |
> 40.0 |
58.5 |
68.9 |
68.9 |
after Table 6 page 988
All Possible Parameter Combinations and 1 Year Probability of Bleeding
|
Class A |
small varices |
medium varices |
large varices |
|---|---|---|---|
|
absent red wale |
6 |
10 |
15 |
|
mild red wale |
8 |
12 |
19 |
|
moderate red wale |
12 |
16 |
24 |
|
severe red wale |
16 |
23 |
34 |
|
Class B |
small varices |
medium varices |
large varices |
|---|---|---|---|
|
absent red wale |
10 |
16 |
26 |
|
mild red wale |
15 |
23 |
33 |
|
moderate red wale |
20 |
30 |
42 |
|
severe red wale |
28 |
40 |
52 |
|
Class C |
small varices |
medium varices |
large varices |
|---|---|---|---|
|
absent red wale |
20 |
30 |
42 |
|
mild red wale |
28 |
38 |
54 |
|
moderate red wale |
36 |
48 |
64 |
|
severe red wale |
44 |
60 |
76 |
Specialty: Gastroenterology
ICD-10: ,
