Glycated Albumin to Glycated Hemoglobin Ratio as a Predictor of Oesophageal varices & its Risk of Bleeding

Abstract

Summary C irrhosis is the end stage of chronic damage to the liver. Portal hypertension commonly accompanies liver cirrhosis with the development of OV and PHG as major complications. Gastrooesophgeal variceal hemorrhage (GOV) is a major complication of portal hypertension resulting from liver cirrhosis. Oesophageal variceal bleeding is one of the most dreaded complications of cirrhosis because of its high mortality. The prevalence of varices in patients with cirrhosis is approximately 60-80%. The incidence of OV increases by nearly 5% per year, and the rate of progression from small to large varices is approximately 5 to 10 % per year. The mortality rate from variceal bleeding is about 17-57 % but when patients are treated optimally in hospital it is found to be only 20%. TheAmericanAssociationfortheStudyofLiverDisease andtheBaveno V ConsensusConferenceonportal hypertensionrecommendedthat allcirrhoticpatientsshouldbescreenedfor the presence of OV when liver cirrhosis is diagnosed. Some authors have suggested repeating endoscopy at 2-3 year intervals in patients without varices and at 1-2 year intervals in patients with small varices so as to evaluate the development or progression of the OV. However, this approach has two major limitations. Endoscopy is an invasive procedure and secondly the cost effectiveness of this approach is also questionable. As only 9-36% patients with cirrhosis are found to have varices on screening endoscopy. It may be more cost-effective to routinely screen patients at high risk for the presence of varices so as to reduce the increasing burden and procedure cost of endoscopy units. Identification of non-invasive predictors of OV and portal gastropathy will enable us to carry out UGE in selected group of patients thus avoiding unnecessary intervention and at the same time not missing the patients at risk of bleeding. The aim of this work is to assess the value of GA/HbA1c ratio as a non-invasive predictor of OV and its risk of bleeding and comparing it with other different non-invasive predictors. The current cross-sectional study was conducted on one hundred cases who presented with established liver cirrhosis of any cause the history, clinical examination, laboratory investigations, ultrasound examination and UGE was done for all cases, Child-Pugh score,MELD score, MELD Na score &GA/HbA1c ratio were calculated from parameters obtained at time of admission. Our patients were classified into 2 groups:  Group I: 86 Patients were found to have OV by UGE.  Group II: 14 Patients had no OV by UGE. This study revealed that GA/HbA1c ratio wasn’t sensitive predictor among patients with OV than those without OV in comparison with MELD Na score, MELD score as well as Child-Pugh score and other predictors as platelet count were significantly higher among patients with OV than those without OV. In multivariate analysis, the present study showed that patients with CTP score ≥5, MELD score≥13 &MELD Na score≥ 18 showed high incidence of presence of OV. It is found that MELD Na score is more accurate than MELD score and CTP score in predicting presence of OV in patients with liver cirrhosis, with MELD Na score diagnostic accuracy 73.3%,MELD score diagnostic accuracy 67.1%,CTP score diagnostic accuracy 68.7%. This study revealed that GA/HbA1C ratio wasn’t sensitive predictor among patients with risky OV than those with non-risky OV in comparison with MELD Na score, MELD score as well as Child-Pugh score and other predictors were significantly higher among patients with risky OV than those with non-risky OV.