### Description

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