Comparison between Various Indices for Non-Invasive Prediction of Esophageal Varices in Hepatitis C Related Liver Cirrhosis

Abstract

SUMMARY T his study aimed to determine the value of PC/SD ratio, P2/MS and APRI to predict the presence of EV in cirrhotic patients. 100 cirrhotic patients at any stage were recruited from Tropical Medicine department and endoscopy unit. Diagnosis of liver cirrhosis was based on clinical, biochemical and imaging background. Our exclusion criteria were: (1) Patients with liver cirrhosis due to causes other than HCV infection, (2) Previous variceal bleeding or endoscopic intervention (sclerotherapy or band ligation), (3) Previous prophylactic treatment with B-blockers, (4) Portal vein thrombosis, (5) Previous surgery for portal hypertension or transjugular intrahepatic porto-systemic shunt stent placement, (6) Patients with hepatocellular carcinoma, hematologic malignancies or sickle cell anaemia and (7) Refusal to sign consent to be enrolled in the study. All patients were subjected to: (1) Informed consent, (2) Detailed history taking, (3) Full clinical examination, (4) Laboratory investigations including: complete blood count, platelet count, serum alanine aminotransferase (ALT), serum aspartate aminotransferase (AST), total bilirubin, serum albumin, INR, (5) Serology for viral hepatitis (HBsAg and HCV Ab), (6) Abdominal ultrasonography and (7) Upper GIT endoscopy for detection and grading of esophageal varices by expert endoscopists. Then all patients were classified according to Child `s classification. The patients were divided into two groups according to the presence of EV (group I: patients with positive EV & group II: patients with negative EV). They were 49 males and 51 females with mean age 53.8±4.8 years old. Child’s classification was Child A and B: 69 (69%) and 31 (31%) respectively. Endoscopic findings showed EV in 76 (76%) patients and GV was found in 3 (3%) and all of them also had EV. PHG was found in 52 (52%) patient. Patients with EV (group I) were then subdivided into two groups (group Ia: patients with risky varices and group Ib: patients with non-risky varices). They were 7 males and 6 females with mean age of 55.2±5.5 years old. Child’s classification was Child A and B: 2 (4.3%) and 11 (37.9%) patients respectively. In our study we found that patients with EV had higher percentage of ascites (27.60 vs 4.20 %), splenomegaly (32.9 vs 0.00 %), jaundice (17.10 vs 0.00 %) and lower limb edema (18.40 vs 0.00 %) on examination. Ultrasonography also showed that patients with EV had higher mean spleen diameter (17.07 vs 15.04) and portal vein diameter (13.58 vs 12.08). Also patients wih EV were found to have lower mean platelet count (85.38 vs 112.71) and albumin levels (3.11 vs 3.5) and higher mean INR (1.3 vs 1.19) and total bilirubin levels (1.36 vs 0.77) than those without EV, and these differences were statistically significant. Patients with risky varices (RV) were found to have higher percentage of lower limb edema (53.8 vs 7.90 %) and ascites (27.60 vs 4.20 %) on examination. Ultrasound examination also showed they have higher mean portal vein diameter (14.7 vs 13.35). They were also found to have lower mean platelet count (66.77 vs 89.22) and albumin (2.7 vs 3.19) levels than those with non-risky varices, and these differences were statistically significant.