Predictive value of non invasive markers in the Assessment of complications of hepatic cirrhosis

Abstract

OBJECTIVE: To determine whether Model for End-stage Liver Disease (MELD) Child-Turcotte-Pugh (CTP) classification, AST to platelet ratio index (APRI), and laboratory tests could predict the presence of esophageal varices (EV) or varices which need prophylactic therapy (medium or large size EV). METHODS: Between January 2012 and May 2013, we prospectively enrolled 60 consecutive patients suffering from hepatitis C virus liver cirrhosis at Internal Medicine Department of determined Hospitals , cairo and They were 22 females and 38 males with a mean age 49.0±8.883 years. The presence of EV (any size and medium or large EV) was correlated with patients' characteristics (MELD, CTP classification, APRI, platelets count, and liver tests). RESULTS: Forty four patients (73%) had EV, of whom 54% (24) had varices which need prophylactic therapy (VPT). INR ≥ 1.4 sec(sensitivity: 80%; specificity: 55%; AUC: 0.867) and platelet count lower than 110x10³ (sensitivity: 85%; specificity: 54%; AUC: 0.856) had the best sensitivity for prediction of OV. The VPT could be predicted by platelet count lower than 99.9x10³ (sensitivity: 65%; specificity: 44%; AUC: 0.342) and total bilirubin higher than 2.34 mgldl(sensitivity: 83%; specificity: 63%; AUC: 0.674). ). In this study the presence of OV could be predicted by MELD score higher than 8.5 (sensitivity: 82%; specificity: 60%; AUC: 0.683). the VPT could be predicted by MELD score higher than 9.1(sensitivity: 81%; specificity: 62%; AUC: 0.657). CONCLUSION: High values on MELD are associated with EV and thrombocytopenia, with varices which need prophylactic therapy. As a result of their low sensitivity and specificity, it is suggested to maintain the recommendation of upper gastrointestinal endoscopy for all patients with cirhosis. Keywords: cirrhosis, esophageal varices, MELD,INR, platelets.