RLLB/Alb ratio: a promising noninvasive diagnostic marker in assessing esophageal varices in cirrhotic patients

Abstract

Background Endoscopy has long been widely used to screen for esophageal varices (EV) in cirrhotic patients. Recurrent endoscopy is a significant burden for the healthcare system of the endoscopic unit as well as uncomfortable and high costs for patients. This study intended to prognosticate Right Liver Lobe Diameter/Serum Albumin Ratio (RLLD/Alb) as a non‐invasive approach in the early diagnosis of EV among chronic liver disease (CLD) Bangladeshi patients enrolled in a specific hospital. Participants and Methods A total of 150 admitted patients with CLD were included in the study. Patients were subjected through a comprehensive biochemical checkup and upper digestive endoscopic or ultrasonographic inspection. The correlation was evaluated between the RLLD/Alb ratio and esophageal varices grades. Results The upper digestive endoscopy demonstration among 150 patients resulted in no EV in 18%, while 24% of patients was identified as EV grade I, 20% as grade II, 20% as grade III, and 18% patients as grade IV. The mean value of the RLLD/Alb ratio was 4.89 ± 1.49 (range from 2.30 to 8.45). The RLLD/Alb ratio diagnosed the EV employing the cut‐off value of 4.01 with 85.3% sensitivity and 68.8% specificity. Furthermore, it was positively correlated with the grading of EV, when this ratio increased the grading of EV increases and vice versa (r = 0.630, p < 0.001). Conclusion The RLLD/Alb ratio is a non‐invasive parameter giving exact guidance relevant to the ascertainment of the existence of EV and their grading in chronic liver disease patients.

Evaluation of right liver lobe size to serum albumin concentration ratio in predicting the presence of esophageal varices in cirrhotic patients taking endoscopy as gold standard

“…Protrusion of dilated veins (>50.0% of normal diameter) into the lumen of esophagus seen on the endoscope was labeled as esophageal varices (True Positive). 12,13 All the data including the demographics were noted into the attached proforma. To eliminate bias, all the laboratory investigations were acquired from the same laboratory (Hospital Lab), all the ultrasonographic measurements of the right lobe of liver were taken by the same consultant of the radiology department and all the endoscopies were performed by the same consultant of the medical department.…”

“…These includes right liver lobe diameter (RLLD)/albumin ratio, albumin-bilurubin (ALBI) score, left liver lobe diameter (LLLD)/albumin ratio, and platelet count/spleen diameter (PC/SD) ratio. 11,12 A study conducted at the Medicine Department, Pakistan Atomic Energy Commission (PAEC), has established the usefulness of right liver lobe diameter (RLLD) to serum albumin (SA) ratio for this purpose in high probability patients. 7 Since the predictive values change with the prevalence of disease and there is no data available to define this relation in the local population, the present study will describe its utility and define this relation in the local community.…”