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: 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.
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