Non-invasive assessment of large esophageal varices with liver cirrhosis ; a study conducted in Pakistan

Abstract

The assessment of non-invasive parameters for the prediction of large esophageal varices among patients with liver cirrhosisis is of utmost importance. In this study, non-invasive parameters for prediction of large esophageal varices were retrospectively evaluated. The presence of esophageal varices grade III and IV was classified as large esophageal varices positive while no varices or grade I and II were classified as large esophageal varices negative. There were 473 (90.09%) patients with ascites [mild 38 (8.03%), moderate 257 (54.33%) and severe 178 (37.63%)]. Frequency of esophageal varices was found to be higher (n=415, 79.04%). Whereas, large esophageal varices were found in 251 (47.81%) patients. The sensitivity, specificity, positive predicted value, negative predicted value and test accuracy of thrombocytopenia in predicting large esophageal varices were found to be 88.05%, 59.85%, 66.77%, 84.54% and 73.33% respectively. A significant association for large esophageal varices was observed for low platelet counts (AOR : 0.98, 95% CI : 0.97-0.99), high bilirubin level (AOR : 1.22, 95% CI : 1.07-1.39), ascites (AOR : 1.98, CI : 1.02-3.85) and Child score A (AOR : 0.26, 95% CI : 0.09-0.75) and Child Score B (AOR : 0.42, 95% CI : 0.28-0.61). In conclusion, low platelet count, high bilirubin level and ascites are found to be non-invasive predictive factor for large esophageal varices. J. Med. Invest. 66 : 248-251, August, 2019

Platelet Count/Spleen Diameter Ratio as a Non-invasive Parameter in the Prediction of Esophageal Varices in Patients with Liver Cirrhosis

“…There was no significance in total leucocytic count (TLC) between patients with varices and without varices, this came in agreement with the study done by Elatty et al [26]. But in disagreement, the study done by Mahmood et al [27] documented a statistically significant relationship between low WBC and varices presence.…”

Correlation of Thrombocytopenia With Grading of Esophageal Varices in Patients With Cirrhosis

“…We verified the significant association between severity of chronic liver disease and the size of esophageal varices. Patients with large varices mostly belonged to class child B and C. This fact has been validated in previous studies 4,17 . So patients with thrombocytopenia and higher child class are more likely to have large varices and at high risk for upper GI bleed.…”

“…In a study done in Pakistan by Mahmood et.al, large varices were found in 47.81% of patients with cirrhosis, and thrombocytopenia was 88.05% sensitive and 59.85% specific for predicting large varices. Lower platelet count showed significant association with large varices 17 . Zubia et al found thrombocytopenia and spleen diameter are significant Indicators for large varices but platelet-count/spleendiameter ratio is definitely more reliable 18 .…”

HEP-Net opinion on the management of ascites and its complications in the setting of decompensated cirrhosis in the resource constrained environment of Pakistan

“…Studies indicate that over 80% of patients admitted with ascites have liver cirrhosis as the cause. 5 - 8 Most common cause of cirrhosis in Pakistan is reported as hepatitis C infection in over half of the such patients. 9…”