Diagnostic Value of Non-invasive Scoring Systems in the Prediction of Esophageal Varices in Patients with Liver Cirrhosis—Single Center Experience (original) (raw)
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Journal of Advances in Internal Medicine
Introduction: Non-invasive assessment of esophageal varices (EVs) may reduce endoscopic burden and cost. This study aimed to evaluate the diagnostic accuracy of non-invasive fibrosis scores (AAR, APRI, FIB-4, King and Lok scores) for the prediction of varices in liver cirrhosis. Methods: This prospective study included 100 liver cirrhosis patients who underwent screening endoscopy for EVs. AAR, APRI, FIB-4, King and Lok scores were assessed. The receiver operating characteristic curves (ROC) were plotted to measure and compare the performance of each score for predicting EVs and to obtain the corresponding optimal prediction value. Results: Of the 100 patients, 70 were males and 30 were females with a mean age of 54.05±11.58 years. Esophageal varices were found in 77 patients out of which 58.44% were high-risk varices. Platelet count and non-invasive fibrosis scores APRI, FIB-4, Lok and King were able to discriminate patients with and without varices. Using area under receiver opera...
Significance of Non-Invasive Markers as Predictor of Esophageal Varices in Liver Cirrhosis
Journal of Nepal Medical Association, 2017
Introduction: Upper gastro-intestinal endoscopy remains the gold standard for screening for esophageal varices but it has its own limitations. It is an invasive, expensive and uncomfortable procedure and needs clinical expertise. Accordingly, this study was conducted to establish the role of non-invasive markers for prediction of esophageal varices in liver cirrhosis. Methods: A hospital based descriptive cross-sectional study was carried out in Liver unit of National Academy of Medical Sciences, Bir Hospital, from October 2016 to September 2017. Complete blood count, liver function test, liver ultrasound and upper gastro-intestinal endoscopy were done for all patients to detect esophageal varices and to correlate with different non-invasive markers. Results: Total 191 patients of liver cirrhosis were studied after exclusion. Platelet count of 92082.00±43435.83/mm3 and spleen size of 144.21±10.71 mm was found to be good predictors of presence of EV (P≤0.001). Significant association...
New Non-Invasive Index for Detecting Esophageal Varices in Patients with Liver Cirrhosis
Open Journal of Internal Medicine, 2016
Introduction: Many studies have shown that clinical, biochemical and ultrasonographic parameter are predictive of the presence and grading of esophageal varices. Aim of Study: Validation of a noninvasive test called P2/MS and its comparison with other noninvasive tests for the detection of high risk esophageal varices. Patients and Methods: We prospectively enrolled 125 consecutive patients with liver cirrhosis. Complete blood count [CBC], Platelet count by direct method, Liver functions [serum bilirubin, AST, ALT, prothrombin time and concentration and serum albumin], kidney functions, hepatitis markers for B & C, abdominal ultrasonography and upper gastrointestinal endoscopy were done for each patient. Calculation of P2/MS [Platelet count) 2 /{monocyte fraction (%) × segmented neutrophil fraction (%)], API [age-platelet index], APRI [AST-to-platelet ratio index], SPRI [spleen-toplatelet ratio index], ASPRI [age-spleen-to-platelet ratio index] scores and correlating the different scores with the grade of esophageal varices found on upper endoscopy. Results: During processing of our patient's data, we found certain relation between segmented neutrophils, monocytes, platelet count, total bilirubin and the degree of esophageal varices for the detection of high risk varices and a new equation was formulated and we called it P2/MS-B. In predicting high risk esophageal varices HREV, the area under the curve for this new variable was [0.909, 95% confidence interval 0.858-0.961, p = 0.000] which was significantly higher than all the other variables including P2/MS for the detection of HREV. The sensitivity of the new equation for the detection of HREV is 85.3%, the specificity is 83.1%, the positive predictive value is 87.9%, the negative predicative value is 86.0 % and the overall accuracy of the test is 85.6%. Conclusion: A newly detected noninvasive variable for detecting HREV may reliably screen liver cirrhosis patients for HREV and avoid unnecessary endoscopy in low risk patients.
Zagazig University Medical Journal
Background: Varices are a serious consequence of portal hypertension, and variceal bleeding is a life-threatening complication occurring in up to 30% of patients with cirrhosis. Despite the great improvement in diagnosis and the available therapeutic modalities, mortality from acute variceal bleeding may still reach up to 20%. Therefore, our aim was to assess the role of noninvasive score modalities in the prediction of the presence of EVs & to predict EVs severity. Methods: This Comparative cross-sectional study was conducted on a cohort of 90 cirrhotic patients. All patients were subjected to investigations include complete blood count, liver and kidney function tests, bleeding profile, random blood sugar, and serum sodium. The following scores were estimated: Child-Pugh score, MELD-Na + score, AAR, APRI, FIB-4, and King's score. Upper GI endoscopy was done for evaluation of presence or absence of EVs. Results: Our results revealed that Kings Score is the most sensitive and specific score in predicting the presence of EVs, followed by APRI score while AAR score has the least sensitivity and specificity.FIB-4 score is the most sensitive scoring system in predicting severe EVs, followed by APRI, Kings, and AAR scores. Regarding specificity, King's Score is the most specific one followed by FIB-4, APRI and AAR. Conclusions: King's score has the highest sensitivity and specificity in EVs prediction followed by APRI. Regarding severe EVs, FIB-4 score is the most sensitive scoring system in the prediction of severe EVs. However, King's score is the most specific one.
Screening of Esophageal Varices by Noninvasive Means in Chronic Liver Disease
Euroasian journal of hepato-gastroenterology
Noninvasive assessment of esophageal varices (EV) decreases the medical and financial burden related to screening and helps in the management of patients with chronic liver diseases (CLDs). In this study, our aim was to assess the utility of the platelet count/spleen diameter index for the noninvasive evaluation of EV. In this cross-sectional observational study, a total of 100 CLD patients underwent screening endoscopy for EV in Medicine and Gastroenterology Department, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh. Platelet count/spleen diameter ratio was assessed in all patients and its diagnostic implication was calculated. Upper gastrointestinal endoscopy revealed that 45 (45.0%) patients had medium EV followed by 27 (27.0%) that had small EV and 19 (19.0%) patients had large EV. Receiver operator characteristic (ROC) curve was constructed using platelet count/spleen index, which gave a cut-off value of >905. The validity of platelet count/spleen index evalu...
Non-Endoscopic Parameters for Predicton of Esophageal Varices
Advances in internal medicine, 2017
Introduction: Non invasive assessment of esophageal varices may improve the management and lower the medical and financial burden related to the screening. In this study, Our aim was to validate the prediction of varices using platelet count/spleen diameter ratio and Alanine transaminase/platelet ratio index (APRI).Methods: Fifty patients with newly diagnosed and treatment naive cirrhosis underwent screening endoscopy along with hematological and ultrsonographic studies. Platelet count/spleen diameter ratio and APRI index were assessed and their diagnostic accuracy calculated. Based on previous studies, a cutoff of 909 was applied for platelet count/spleen diameter ratio and cutoff of > 1.3 for APRI. The diagnostic accuracy of both the indices were further evaluated for severity and size of varices.Results: Prevalence of varices was 36% out of which 24% were large varices. Platelet count/spleen size diameter, portal vein diameter and APRI index had significant association for pre...
Predictors of esophageal varices and first variceal bleeding in liver cirrhosis patients
World Journal of Gastroenterology, 2017
AIM To assess "predictors" of esophageal varices (EV) and variceal bleeding using non-invasive markers in Albanian patients diagnosed with liver cirrhosis. METHODS One hundred thirty-nine newly diagnosed cirrhotic patients without variceal bleeding were included in this analysis. Model for end-stage liver disease (MELD), aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AST/ALT), AST to platelet ratio index (APRI), platelet count to spleen diameter (PC/SD), fibrosis-4-index (FIB-4), fibrosis index (FI) and King's Score were measured for all participants. All patients underwent endoscopic assessment within two days of hospitalization. The major end point was the first esophageal variceal bleeding (EVB) event. The diagnostic performance of "predictors" for the presence of EV and EVB were assessed by sensitivity and specificity values obtained from the receiver operating characteristics procedure. RESULTS FIB-4 was the only strong and significant "predictor" of esophageal varices (multivariable-adjusted OR = 1.57 for one unit increment; 95%CI: 1.15-2.14). Furthermore, a cutoff value of 3.23 for FIB-4 was a significant predictor of esophageal varices, with a sensitivity of 72%, a specificity of 58% and a proportion of area under the curve (AUC) of 66% (P = 0.01). During the
2021
Background: Liver cirrhosis and portal hypertension causes esophageal variceal (EV) formation, which can cause variceal bleed with significant mortality. But, endoscopic screening, in a resource constrained setup like India,is not feasible for entire cirrhotic population. Hence there has always been a need for noninvasive predictive factors of EV and hence, umpteen studies have been done in this regard. Materials and Methods: This cross sectional study was conducted in 70 patients with compensated cirrhosis. We assessed parameters like Model of end stage liver disease (MELD) score, fasting blood ammonia, platelet count (PC)and platelet count/bipolar spleen diameter ratio(PC/SD). Results: All these four parameters were found to have significant association in prediction of presence or absence of EV in the study group{ 9.46 ± 1.46 vs 7.56 ± .70, (81.19Umol/l) ± 10.59 vs (52.11Umol/l) ± 9.70, 119346 ± 30986 vs 189611 ± 37595 and 856 ± 140 vs 1460 ± 204, } respectively ( p values <.0...
The Turkish Journal of Gastroenterology
Background/Aims: Endoscopy as a screening modality for esophageal varices is becoming difficult because of its invasiveness, cost, and increased burden of liver cirrhosis. This study aims to determine the diagnostic accuracy of simple and noninvasive markers in detecting esophageal varices. Materials and Methods: Four variables (platelet count, portal vein diameter, splenic diameter, and ratio of platelet count to splenic diameter PC/SD] ratio) were studied in 150 cirrhotic patients. Endoscopy was performed to detect esophageal varices in the patients. The diagnostic accuracy of these variables was determined by obtaining area under the receiver operating characteristic (ROC) curve (AUC). The cutoff value of each variable and its sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were obtained using the Youden index. Pairwise comparison of these variables was performed using the Hanley and McNeil method to determine the most reliable screening tool among them. Results: The PC/SD ratio was the most reliable indicator for the presence of varices: AUC=0.9 (p<0.0001; cutoff value, ≤1077.42; sensitivity, 88.75%; specificity, 81.43%). The AUC for platelets and splenic diameter was 0.85 (p<0.0001) and 0.77 (p<0.0001), respectively, showing they were also good indicators. The portal vein diameter was not a good predictor for esophageal varices (AUC=0.59). Pairwise comparison of these variables showed that the PC/SD ratio is statistically significant for predicting esophageal varices among these markers (p<0.05). Conclusion: The PC/SD ratio is found to be the most reliable marker to prognosticate esophageal varices. It is easy to obtain and can be used with other markers to identify the high-risk patients for developing esophageal varices. It will definitely reduce the need for endoscopy as screening purposes and lower the medical expenditures.
Journal of Translational Internal Medicine, 2014
Background: Esophageal varices (EVs) are serious consequences of liver cirrhosis. Several studies have evaluated the possible non-invasive markers for the diagnosis of EVs to reduce the number of endoscopic procedures in patients with cirrhosis but without varices. This study was performed to evaluate the diagnostic performance of two such parameters (platelet count to splenic diameter ratio and splenoportal index) for the detection of EVs. Materials and Methods: A total of 111 patients with liver cirrhosis were analyzed after performing upper gastrointestinal endoscopy and non-invasive tests including platelet count and ultrasound abdomen including Doppler study. Appropriate statistical tests were applied to compare the non-invasive tests with the gold standard of endoscopy. Results: Of 111 liver cirrhotics, 80 (72.1%) were male and 31 (27.9%) were female. EVs were present in 68 (61.3%) patients and absent in 43 (38.7%) patients. In platelet count to splenic diameter ratio, a cut-o...