Evaluation of Venous Ammonia Level, Splenic Longitudinal Diameter, Portal Vein and Splenic Vein Diameters as Non-Invasive Indicators for the Presence of Portosystemic Collaterals in Egyptian Cirrhotic Patients

Abstract

Introduction and Aim of the Work: The identification of cirrhotic patients with esophageal varices or other portosystemic collateral by non-invasive means is appealing in that it could decrease the necessity of endoscopic screening. This study was to evaluate the diagnostic utility of venous ammonia level with other ultrasonographic parameters as non-invasive markers for the presence of portosystemic shunts. Patients and methods: The study included 3 groups of Child Pugh class A and early B patients. Group (A): 25 patients with evidence of both esophageal varices and portosystemic collaterals; group (B) 25 patients with neither evidence of varices nor portosystemic collaterals and group (C): 25 patients with evidence of varices but no collaterals. Measurement of venous ammonia level was done for all patients. Results: serum ammonia level was significantly higher in group A (222.8 ± 54 μg/dL) than that in group B (85 ± 21.1 μg/dL) and group C (148.2 ± 19.6 μg/dL). The cutoff value of serum ammonia level 113 μg/dL was a good predictor for the presence of esophageal varices, while the cutoff value of serum ammonia level at 133 μg/dL was a good predictor for the presence of both esophageal varices and abdominal collaterals. Combination of portal vein diameter > 13mm + splenic vein diameter > 8.9mm + ammonia level > 133 μg/dL gives 100% of sensitivity and 96% of specificity for the prediction of the presence of portosystemic shunts. Conclusion: Determination of serum ammonia level, splenic, portal vein and M. F. Montasser et al. splenic vein diameters are considered as good predictors for the presence of portosystemic shunts in patients with liver cirrhosis.

Non-Invasive Parameters of Oesophageal Varices Diagnosis: Which Sensitive and Applicable; A Pilot Study

“…SVD of 8.8 mm or more was a good predictor for the presence of OV with 97% sensitivity and 82% specificity. This was matched to findings of Montasser et al [23] who found that splenic vein diameter ≥ 8.9 mm can predict the presence of OV in cirrhotics with 98% sensitivity and 84% specificity.…”

Non-Invasive Prediction Models for Esophageal Varices and Red Signs in Patients With Hepatitis B Virus-Related Liver Cirrhosis

“…Hypertension of the splenic vein leads to an increased diameter. This causes congestion in the spleen, and consequently, splenomegaly ( Merli et al, 2003 ). Studies have shown that the splenic vein diameter of patients with cirrhosis with HREVs is significantly higher than that of patients with low-risk EVs or healthy controls ( Jamil et al, 2017 ).…”

“…The incidence of transition from compensated to decompensated cirrhosis is 5–7% per year ( D'Amico et al, 2006 ). As one of the major complications in patients with cirrhosis, esophageal varices (EVs) occur at a rate of 7–8% per year, which may be higher in patients with decompensated cirrhosis ( Merli et al, 2003 ). Esophageal variceal bleeding (EVB) is a serious and life-threatening complication in patients with cirrhosis.…”

“…In the last two decades, much effort has been devoted to finding non-invasive methods of predicting the presence of EVs and HREVs. Currently, non-invasive predictive parameters are predominantly imaging/ultrasonographic and laboratory parameters, including spleen diameter, spleen/liver stiffness, portal/splenic vein diameter, platelet count, platelet count to spleen diameter ratio, Fibrosis-4 score (FIB-4), aspartate aminotransferase to platelet ratio index (APRI), and aspartate aminotransferase to alanine aminotransferase ratio (AAR) (Giannini et al, 2003;Giannini et al, 2006;Hong et al, 2009;Kim et al, 2010;Colecchia et al, 2012;Berzigotti et al, 2013;Montasser et al, 2014;Morishita et al, 2014;Rockey et al, 2016). A few studies have reported the non-invasive prediction of EVB (Kothari et al, 2019;Wan et al, 2021) and large EVs (Sharma and Aggarwal, 2007;Lijing et al, 2014).…”

Evaluation of the blood ammonia level as a non-invasive predictor for the presence of esophageal varices and the risk of bleeding

“…Other studies have been performed on this point. El-Hefny et al (23) reported a cutoff value of 77.5 umol/L (108.5 μg/dL) ammonia with 100% sensitivity and 95% specificity for the detection of EV, whereas Tarantino et al 2009 (11) reported a different cutoff value of 42 umol/L (58.8 μg/dL) with a sensitivity 97% and a specificity 43%.…”