Evaluation of Serum Fibrosis marker (FiB4) as a Predictor for Esophagogastric Varices in HCV Cirrhotic Patients

Abstract

SUMMARY T his study was conducted to evaluate Serum Fibrosis marker FiB4 as a Predictor for the presence of Esophagogastric Varices in HCV Cirrhotic patients To fulfill the aim of our study, 100 cirrhotic patients at any stage were recruited from Tropical Medicine department, Tropical outpatient clinic and endoscopy unit. Diagnosis of liver cirrhosis was based on clinical, biochemical, imaging, and histopathological background or fibroscan whenever needed. Our exclusion criteria were: (1) Patients with active gastrointestinal bleeding, (2) Patients who underwent previous band ligation or variceal sclerotherapy, (3) Patients who underwent Trans jugular intrahepatic Porto systemic stent shunt, or surgery for portal hypertension, (4) Presence of portal vein thrombosis, (5) Presence of Hepatocellular carcinoma, (6) Patients taking drugs for primary prophylaxis of variceal bleeding, (7) Patients with active (< 6 months of alcohol abstinence) alcohol abuse, (8) Advanced other organ malignancy, (9) Other severe medical condition (end stage renal disease, congestive heart failure or severe respiratory syndrome), (10) Patients with other causes of splenomegaly or thrombocytopenia (hematological disease), (11) Patients with bilhariziasis or history of canal water exposure. At the beginning all included recipients were subjected to: (1) Informed consent, (2) Full history taking, (3) complete clinical examination, (4) Biochemical examination including (Complete blood count, Liver profile tests (ALT, AST, Albumin, PT, alkaline phosphatase, total bilirubin, INR) and Serum creatinine), (5) Upper gastrointestinal endoscopy for detection of any EV, (6) Ultrasonography of the abdomen was done. (7) All patients were classified according to Child-Pugh's criteria. The patients were divided into two groups according to the presence of EV (patients with positive EV & patients with negative EV). There were 58 males and 42 females with mean age (46.24±7.05 years). In our study 67.0 % of patients had EV and 40% had HREV. We found the Child’s classification in Child A, B, C was 41 (41%), 33 (33%), 26 (26%) respectively. Endoscopic findings showed EV in about 67% and large EV was 39%. The PHG was found in 56%. The prevalence of EV in Child A, B, C was 29.3%, 879%, 100% respectively. In this study, the prevalence of ascites by abdominal ultrasonography (p<0.000) was significantly higher in patients with varices than those without. Serum albumin level was found to be significantly lower in patients with EV than patients without EV (p<0.001). Platelet count was significantly lower in the patients with varices in our study than those without (p<0.001). Platelet count was lower among patients with HREV than those without HREV (104.20 ± 26.96v/s 115.37 ± 26.96; p=0.101) and this was statistically insignificant in prediction of HREV. Ultrasonography showed that average portal vein diameter (PVD) was found to be significantly larger in patients with EV than patients without EV (p<0.000) (13.73 ± 1.81vs 10.79 ± 2.12 mm). Furthermore, PVD was found to be significantly larger in patients with HREV than patients without HREV (p<0.000) (14.35 ± 1.93vs 12.81 ± 1.11mm). As regards to Spleen diameter, this study revealed larger spleen diameter was highly significantly (P<0.001) in patients with EV when compared to patients without EV. Large Spleen diameter was observed in HREV patients compared with no HREV patients (162.80 ± 15.55vs 154.81 ± 8.71mm; p=0.018) and this was statistically significant in prediction of HREV. In the current study, the presence of EV was significantly higher in Child B patients and Child C patients compared to Child A patients (87.9%,100%, 29.3%)respectively with p value<0.001. Also, the presence of HREV was significantly higher in Child B and C patients compared to Child A patients. These results indicated that the patients with Child B and C cirrhosis are at a higher risk of development of varices and higher risk of bleeding. In the current study, the sensitivity of FIB4 for prediction of EV was 71.64%, specificity was 84.85 % with the best cut off point value >3.46. Furthermore, the sensitivity of FIB4 for prediction of HREV was 65.00%, specificity was 70.37 % with the best cut off point value >4.06.