Significance of Non-Invasive Markers as Predictor of Esophageal Varices in Liver Cirrhosis

  • Dipendra Khadka Liver Unit, Department of Medicine, NAMS, Bir Hospital, Kathmandu, Nepal
  • Sushil Prajapati Liver Unit, Department of Medicine, NAMS, Bir Hospital, Kathmandu, Nepal
  • Sudhamshu KC Liver Unit, Department of Medicine, NAMS, Bir Hospital, Kathmandu, Nepal
  • Jeetendra Kaji Shrestha Liver Unit, Department of Medicine, NAMS, Bir Hospital, Kathmandu, Nepal
  • Niyanta Karki
  • Bikash Jaishi Liver Unit, Department of Medicine, NAMS, Bir Hospital, Kathmandu, Nepal
  • Kiran Regmi Liver Unit, Department of Medicine, NAMS, Bir Hospital, Kathmandu, Nepal
  • Sandip Khadka Liver Unit, Department of Medicine, NAMS, Bir Hospital, Kathmandu, Nepal
Keywords: esophageal varices; liver cirrhosis; non-invasive markers; portal hypertension; upper gastro-intestinal.

Abstract

Introduction: Upper gastro-intestinal endoscopy remains the gold standard for screening for esophageal varices but it has its own limitations. It is an invasive, expensive and uncomfortable procedure and needs clinical expertise. Accordingly, this study was conducted to establish the role of non-invasive markers for prediction of esophageal varices in liver cirrhosis.

Methods: A hospital based descriptive cross-sectional study was carried out in Liver unit of National Academy of Medical Sciences, Bir Hospital, from October 2016 to September 2017. Complete blood count, liver function test, liver ultrasound and upper gastro-intestinal endoscopy were done for all patients to detect esophageal varices and to correlate with different non-invasive markers.

Results: Total 191 patients of liver cirrhosis were studied after exclusion. Platelet count of 92082.00±43435.83/mm3 and spleen size of 144.21±10.71 mm was found to be good predictors of presence of EV (P≤0.001). Significant association between Child-Turcotte-Pugh class and presence of varices was observed (P≤0.001). AST/ALT ratio with cutoff value of 1.415 showed sensitivity of 82.4% and specificity of 36.4%. APRI at a cutoff value of 1.3 showed a sensitivity of 83.2% and specificity of 50%.

Conclusions: Platelet count, spleen size and Child-Turcotte-Pugh class are good predictors of presence of esophageal varices in patients with liver cirrhosis. AST/ALT ratio and APRI score are not good substitutes for upper gastro-intestinal endoscopy.

 

Keywords:  esophageal varices; liver cirrhosis; non-invasive markers; portal hypertension; upper gastro-intestinal.

Published
2017-12-31
Section
Original Article