Relation of Different Grades of Esophageal Varices and Meld Score in Patients with Liver Cirrhosis

Abstract

The purpose of our study was to prospectively develop and evaluate the accuracy of MELD score for predicting the presence or absence of esophageal varices in patients with liver cirrhosis by using endoscopy as the reference standard. Such a non invasive index should have a confident safety profile (i.e., a negative predictive value approaching 100%), so as to avoid missing the diagnosis in patients at risk, and a relative cost benefit profile so as to avoid unnecessary endoscopy and / or treatment of patients who would not benefit from therapy (i.e., high positive predictive value). The indices were chosen in our study seem to fulfill these requirements and is based on a pathophysiological criteria as well. So, our study tested that the use of MELD score for the prediction of esophageal varices may lead to an increase in diagnostic accuracy for esophageal varices. In conclusion MELD score could be used as a noninvasive predictor of esophageal varices with a cut-off value ≥ 8.7, sensitivity 92.5% and specificity 85%. Also it could be used in differentiating grades I, II from grades III, IV with cut-off value ≥ 12.15 , sensitivity 55% and specificity 90%. This means that it’s highly sensitive in predicting the presence of varices and more specific to grades III, IV. With such a high negative predictive value of the model we can say that, if we were applying the MELD score for screening the oesophageal varices, we would spare a respectable number of upper gastrointestinal endoscopy with avoiding its complications and saving the effort and money of the gastrointestinal endoscopy unit. Finally, we can conclude that MELD score managed to offer valuable information regarding the diagnosis and grades of oesophageal varices. We believe that these noninvasive predictors like MELD score in our study may be of help to the physicians practicing in rural areas where endoscopy facilities are not readily available, in helping them to initiate appropriate primary pharmacological prophylaxis in these patients. In an urban setting where the endoscopy workload is high, a non invasive predictor, as in this study, can help one to initiate drug therapy while waiting for the endoscopy procedure.