Laboratory and Ultrasonographic predictors of oesophageal varices in cirrhotic patients | ||
| Sohag Medical Journal | ||
| Article 26, Volume 22, Issue 3, October 2018, Pages 223-230 PDF (310.98 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/smj.2018.33804 | ||
| Authors | ||
| Ghada Moustafa Galal1; Amr Mohamed Zaghloul1; Rania Ashraf Aref2 | ||
| 1Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Sohag University. | ||
| 2Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Sohag University | ||
| Abstract | ||
| Portal hypertension in cirrhosis results from progressive fibrotic remodeling of the liver, which increases the resistance to hepatic sinusoidal blood flow. Increased portal venous pressure causes esophageal and gastric varices, which contribute substantially to cirrhosis-related morbidity and mortality. The gold standard in the diagnosis of varices esophagogastroduodenoscopy (EGD) but identification of non –invasive predictors of oesophageal varices (OVs) will allow upper gastrointestinal (GIT) endoscopy to be carried out only in selected group of patients . Different non-invasive parameters including clinical, laboratory and sonographic predictors were suggested an alternative approach to perform selective screening endoscopy only in patients at high risk. Objective: Our objective is to evaluate whether the NIHCED (non-invasive hepatitis C related cirrhosis early detection) score and the right lobe diameter to albumin ratio can predict the presence of esophageal varices in patients with liver cirrhosis. Patients and method: This prospective study included seventy-five patients with liver cirrhosis, all patients were evaluated clinically and ultrasonographically. complete blood count, liver function tests, calculation of NIHCED score and right lobe diameter to albumin ratio. Upper GIT endoscopy were done to all of them for detection of oesophageal varices. Results In total 75 patients were included (51 males and 24 females) with mean age 53.11±9.89. All 75 patients were segregated into two groups those with oesophageal varices and those without oesophageal varices. Roc curve analysis of NIHCED score was applied to both goups with a cut off score of >45. It had a sensitivity of 70%, specifity of 78%, and diagnostic accurancy of 74% with an AUC of 0.77 (95% CI, 0.66-0.86). Roc curve analysis of right lobe diameter to albumin ratio was applied to both groups with a cut off score of >2.80. It had a sensitivity of 80%, specifity of 53%, and diagnostic accurancy of 67% with an AUC of 0.67 (95% CI , 0.55-0.77). Conclusions: The NIHCED score and right lobe diameter to albumin ratio were simple non-invasive predictors of presence of varices in patients with liver cirrhosis. | ||
| Keywords | ||
| Liver cirrhosis; Oesophageal varices | ||
| References | ||
|
(1)Schaffner H, Popper (1963): Capillarization of the sinusoids. Gastroenterology 44:339–42. (2) Garcia-Tsao G, Groszmann RJ, Fisher RL, et al. (1975): Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology 5:419-24.
(3) Naeije R (2003). Single beat estimation of right ventricular end systolic pressure volume relationship. Am J Physiol Circ Physiol 284:1625-30.
(4) Sarwar S, Khan AA, Alam A, et al. (2004): Non-endoscopic prediction of esophageal varices in cirrhosis. J Coll physicians Surg Pak 15(9):528-31.
5) Alempijevic T, Bulat V, Djuranovic S, et al. (2007): Right liver lobe/albumin ratio: contribution to non-invasive assessment of portal hypertension. World J. Gastroenterol 13: 5331–5.
(6) Bejarano G, Vergara M, Gil M, et al. (2009): Prospective evaluation of liver fibrosis in chronic viral hepatitis C infection using the Sabadell NIHCED (non-invasive hepatitis C related cirrhosis early detection) index. REV ESP ENFERM DIG 5 : 325-35.
(7) Huber A, Ebner L, Heverhagen J, et al. (2015): State-of-the-art imaging of liver fibrosis and cirrhosis: A comprehensive review of current applications and future perspectives. European journal of radiology open 2: 90-100.
(8) De Franchis and Primignani M (2001): Natural history of portal hypertension with cirrhosis. Clin Liver Dis 5: 645-63
(9)Peck-Radosavljevic M (2000): Thrombocytopenia in liver disease. Can J Gastroenterol. 14(Suppl D):60D–6D
(10) Domenicali M, Baldassarre M, Giannone FA, et al. (2014): Posttranscriptional changes of serum albumin: clinical and prognostic significance in hospitalized patients with cirrhosis. Hepatology 60:1851–60
(11)Mandal L, Mandal SK, Bandyopadhyay D et al. (2001): Correlation of portal vein diameter and splenic size with gastroesophageal varices in cirrhosis of liver. J Ind Aca Clin Med 12(4):266-70
(12) Farooqi JI, Ahmed H, Ikramullah Q, et al. (2007): Predictors of esophageal varices in patients of liver cirrhosis. JPMI 21(1):60-64.
(13) Dumont AE, Amorosi E, Stahl WM (1970): Significance of splenomegaly in patients with hepatic cirrhosis and bleeding esophageal varices. Ann Surg 171:522-6.
(14) Dib N, Konate A, Oberti F, et al. (2005): Non-invasive diagnosis of portal hypertension in cirrhosis. Application to the primary prevention of varices. Gastroenterol Clin Biol 29(10):975-87.
(15) Caletti GC, Bolondi L, Arienti V, et al. (1983): Assessment of gastroesophageal collateral veins in portal hypertension by means of endoscopic ultrasonography Gut 24: 45
(16) El ray A, Azzab M, Mohamed I, et al. (2015): Non-invasive predictors for the presence, grade and risk of bleeding from esophageal varices in patients with post hepatitic cirrhosis. J. Egypt. Soc. Parasitol 45: 421–8.
(17) Obrador BD, Prades MG, Gَmez MV, et al. (2006): A predictive index for the diagnosis of cirrhosis in hepatitis C based on clinical, laboratory, and ultrasound findings. Eur J Gastroenterol Hepatol 18: 57-62
(18) Vergara M, Gil M, Dalmau B, et al. (2008): Historia natural del carcinoma hepatocelular en una cohorte de pacientes de un hospital comarcal. Rev Esp Enferm Dig 100: 682-7 | ||
|
Statistics Article View: 188 PDF Download: 221 |
||
