No abstract

Introduction: Endoscopy for the screening of esophageal varices (EVs) is costly and cannot be performed in remote areas with limited resources. Recently, certain non-invasive cost effective models have been proposed for the prediction of EVs but have failed recommendation on a larger scale. EVendo score is a recently developed bedside score for the detection of EVs. Therefore, our aim was to determine the utility of EVendo score as a screening tool for the detection of high risk esophageal varices in Pakistani population. Methods: It was a cross sectional study which was conducted in the department of Hepatogastroenterology from January 2021-June 2022.All the patients of either gender aged greater than 18 years with newly diagnosed cirrhosis were included in the study while those patients with prior history of esophageal varices and variceal bleeding as well as those with acute liver failure, renal impairment, non-cirrhotic portal hypertension and those on anticoagulants were excluded from the study. Area under the receiver operating curve (AUROC) was obtained for EVendo score, Aspartate Transaminase to platelet ratio(APRI) and Platelet count to Splenic Diameter and diagnostic accuracy was obtained for these scores in predicting EVs and also in identifying HRVs. Results: A total of 272 patients were enrolled in the study. Among them, 167(61.4%) were males. Most common cause of chronic liver disease was viral hepatitis.On screening endoscopy, EVs were noted in 118(43.4%) patients while high risk EVs (HRV) were noted in 47(17.3%) patients respectively. AUROC was obtained for EVendo score, APRI and Platelet count to Splenic Diameter in predicting EVs and also for identifying HRVs and it was 0.93 (p-value <0.001), 0.821(<0.001) and 0.842(p<0.001) respectively for the prediction of EVs with diagnostic accuracy of 86.76% and 0.852 (p-value <0.001), 0.835(<0.001) and 0.814(p<0.001) respectively for identifying HRVs with a diagnostic accuracy of 84.19%. Conclusion: The performance of EVendo score was reliable and better than the other non-invasive scores in predicting EVs in our population with an excellent sensitivity and diagnostic accuracy in predicting the EVs and also in identifying HRVs. However, studies comprising larger sample sizes are required in this regard.

Introduction: Hepatocellular carcinoma (HCC) is one of the most common malignancies with high morbidity and mortality. Recently, the use of inflammatory and molecular biomarkers has been advocated to predict the prognosis in HCC patients after surgical hepatectomy. However, little work has been done to evaluate the use of these inflammatory markers in predicting post TACE HCC recurrence. The aim of our study was to compare different bed side scores in predicting recurrence post TACE in patients with HCC. Methods: It was a cross-sectional study. All the patients with HCC undergoing TACE were included in the study. AUROC was derived for different scores including Lympocyte to Monocyte Ratio (LMR), Platelet to Lymphocyte Ratio (PLR), Neutrophil to Lymphocyte Ratio (NLR), Platelet to White blood cell Ratio (PWR) and NLR/Albumin(ALB) and their sensitivity, specificity, PPV, NPV and diagnostic accuracy were calculated for predicting post TACE recurrence in HCC patients. Results: A total of 323 patients were included in the study. Among them, 281 (87%) were males. Mean age was 53612.5 years. Mostly patients had single tumor 274(84.8%). BCLC stage A was noted in 274(84.8%) and stage B was seen in 49(15.2%) patients. Post TACE, patients were followed up to 1 year. Recurrence was noted in 186(57.6%) patients. On non-invasive investigations, increased neutrophils (p 5 # 0.001), monocytes (p 50.002), platelets (p 5 0.004), serum alpha-fetoprotein (p 5 #0.001) and decreased lymphocytes (p 5 #0.001) and serum albumin (p 5 #0.001) at baseline were significantly associated with post -TACE recurrence. NLR, PLR, LMR, PWR and NLR/Albumin ratio were calculated and multivariate analysis was done showing significant association of PLR, NLR and LMR with post TACE recurrence. Area under the curve was also obtained for these scores. The area under the curve of PLR (AUC:0.90) for predicting recurrence post TACE was higher than that of NLR (AUC:0.84), LMR(AUC:0.82), NLR/Albumin(AUC:0.75) and PWR(AUC:0.60). Sensitivity, specificity, PPV, NPV and diagnostic accuracy for each score was calculated. At a cutoff of .3.4, the sensitivity, specificity, PPV, NPV for PLR were 98.4%,72.3%,82.8%,97% with diagnostic accuracy of 87.3% in predicting post TACE recurrence of HCC. Conclusion: Different non-invasive scores for prediction of post TACE HCC recurrence have been compared and the diagnostic accuracy was highest for platelet to lymphocyte ratio (87.3%). However, further studies are needed to validate these scores.

Introduction: Guidelines recommend periodic endoscopic surveillance for the detection of esophageal varices. However, its avoided by certain patients due to invasiveness and high cost. Identification of noninvasive methods will allow appropriate patient selection. The aim is therefore, to compare the diagnostic performance of different non-invasive indices in predicting esophageal varices. Methods: This was a cross-sectional prospective study which was conducted at the Department of Hepatogastroenterology, Sindh institute of Urology and Transplantation from July 2021 to December 2021.All patients recently diagnosed with liver cirrhosis were included in the study. Upper GI endoscopy was performed in each patient for the detection of esophageal varices. Area under ROC was obtained to determine

Introduction: Most of the lactate in the body is cleared in the liver. Tissue hypoxia results in increased production of lactate and decreased utility of it. Hepatic insult results not only an increase in the blood lactate levels but also is an independent prognostic marker in critically ill cirrhotic patients. Alteration of liver function is indicated by rise in serum bilirubin. The aim of this study was to therefore to assess the utility of blood lactate to Bilirubin index (LBi) in predicting mortality in patients with acute on chronic liver failure (ACLF). Methods: This prospective observational study was conducted from January 2019 to June 2021 at the Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation. Patients aged > 12 years and presenting ACLF were included and their baseline characteristics were recorded. Primary outcome was observed in terms of 30-days mortality and secondary outcome was six months mortality. These indices were then used to calculate the lactate to bilirubin index (LBi) as [1000 × lactate (mmol/L) × bilirubin (µmol/L)]/2. Area under Receiver operating curves (AUROC) for LBi, Child Turcotte Pugh score(CTP) and Model for End-stage Liver Disease score (MELD)  were obtained in predicting both 30 days and six months mortality  and at an optimal cutoff sensitivity, specificity and diagnostic accuracy for these scores were calculated. Results: A total number 159 patients with ACLF were included in the study. Most of the patients were young with mean age of 35.1 ±16.8 years. Males were 97(61%). Hepatitis C was the most common cause of chronic liver disease followed by hepatitis B and autoimmune hepatitis seen in 41 (25.8%), 39(24.5%) and 36 (22.6%) respectively. Hepatitis E was the most common cause of acute injury noted in 60 (37.7%) patients. The baseline characteristics showed mean serum lactate levels of 0.93±1.33 mmol/L, bilirubin levels of 258.5 ± 155.3 µmol/L, CTP score of 10.7 ± 1.8 and MELD score of 26 ±7.6. Out of 159 patients, 26 (16.4%) patients died within 30 days due to ACLF related complicaitons while 133 (83.6%) were discharged. AUROC obtained for LBi, CTP score and MELD score in predicting 30-day mortality in ACLF was 0.98, 0.79 and 0.78 respectively. A cut off of ≥11.8 for LBi Index, ≥30 for MELD score and ≥13 for CTP score were significantly associated with increased risk of 30-day mortality in ACLF patients in our population. However, the sensitivity, specificity, PPV, NPV and diagnostic accuracy of LBi in predicting 30-day mortality was significantly higher than that of CTP and MELD score. The diagnostic accuracy of LBi in predicting 30 days mortality was 87.5%. Similarly, AUROC obtained for LBi, CTP score and MELD score in predicting 6-month mortality in ACLF was 0.89, 0.72 and 0.66 respectively and the diagnostic accuracy of LBi dropped down to 76.6% with a sensitivity of 49.28%, specificity of 97.28%, PPV of 94.4% and NPV of 71.54%.           Conclusion: Our results showed that LBi score of >11.8 had an excellent sensitivity and specificity in predicting mortality in ACLF with an excellent diagnostic accuracy in predicting one month mortality as compared to the other scores. However, its utility in predicting long term mortality is yet to be proven. Further studies are needed to validate this index.

Background: Biliary strictures(BS) possess challenging diagnosis, requiring a multidisciplinary approach. In gastrointestinal clinical practice, the occurrence of biliary strictures is quite common. Multiple diagnostic techniques are used to examine BS in which endoscopic management is considered comparatively effective and non-invasive intervention. Objective: The study aimed to observe the impact of the endoscopic management of unresectable malignant biliary strictures on the patients' quality of life (QoL). Methodology: This cross-sectional study was conducted at the Surgical Ward IV Civil Hospital Karachi, Pakistan. A total of 80 patients with diagnosed unresectable malignant stricture, aged between 18 to 70 years, those with disease duration of more than eight weeks and life expectancy > 1 month were included in the study. In addition to the baseline characteristics along with the pre and post-treatment quality of life was assessed, and the mean values were compared statistically using SPSS version 19.0. Results: The mean total score of QoL improved from 71.47 ± 0.88 at baseline to 84.12 ± 1.93 after 30 days of endoscopic management of unresectable malignant biliary strictures. Conclusion: There was a significant improvement in the patient's QoL after 30 days of endoscopic management of unresectable biliary stricture.

The liver biopsy is the gold standard for the diagnosis of liver fibrosis, because of its invasiveness, high cost and lack of repeatability its use is limited. A new parameter widely used these days for evaluating the grade of hepatic fibrosis is the gamma-glutamyl transpeptidase (GGT)-to-Platelet ratio (GPR) and has shown great benefit in this regard. The aim of our study was to evaluate the role of GPR as a noninvasive predictor of liver fibrosis in patients with chronic hepatitis C in the study population. Methods: All patients with chronic hepatitis C and compensated liver disease were included in the study after informed consent. Patient’s baseline characteristics were recorded. Patient’s baseline Complete blood count (CBC) and Liver function tests were also recorded. Patients then underwent shear wave elastography (SWE) to stratify the degree of fibrosis. These indices were used to calculate Gamma glutamyl transpeptidase (GGT) / platelet ratio. Results were presented as means ± SD for quantitative data or as numbers with percentages for qualitative data. Continuous variables were analyzed using the Student’s t-test; while categorical variables were analyzed using the Chi-square test. A p value of <0.05 was considered statistically significant. Results: A total of 91 patients were included in the study. Out of 91 patients, 56(61.5%) were males. At baseline, 57(62.6%) patients had ≥F3 fibrosis (advanced fibrosis or cirrhosis). Mean GPR was 1.5±2.1. Area under ROC (Receiver Operating Curve) was obtained for GPR in predicting advanced liver fibrosis (≥F3) was 0.8 (p-≤0.001). Higher GPR values were significantly associated with prediction of advanced liver fibrosis (≥F3) in patients with chronic hepatitis C with a sensitivity was of 94.74%, specificity of 62%, positive predictive value of 80.69%, negative predictive value was of 87.50% and diagnostic accuracy of 82.42%. Conclusion: The GPR found to be significantly associated with liver fibrosis in HCV patients presented in our clinic. However, further studies are needed to validate the role of GPR in predicting liver fibrosis.

No abstract