Value of Non-Invasive Scores and Modalities in Predicting the Presence of Esophageal Varices in Patients with Liver Cirrhosis | ||||
| The Egyptian Journal of Hospital Medicine | ||||
| Article 29, Volume 88, Issue 1, July 2022, Page 2464-2471 PDF (446.53 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejhm.2022.236810 | ||||
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| Authors | ||||
Heba A. Faheem   ; Marwa Ahmed Mohamed; Engy Ezzat Eid; Nouran Mohamed Said
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| Internal medicine department , Gastroenterology and hepatology unit, Faculty of Medicine, ain shams University, Cairo, Egypt | ||||
| Abstract | ||||
| Background: Esophageal varices (EVs) represent the main complication of portal hypertension and carry a significant risk of morbidity and mortality. Esophagogastroduodenoscopy (EGD) is the gold standard test for screening of esophageal varices in patients with cirrhosis, but many studies explored noninvasive modalities in order to overcome its cost and invasiveness. Objective: The aim of the current work was to assess the potential role of five non-invasive scoring systems/modalities (AST to platelet ratio index {APRI} score, ALT/AST ratio {AAR}, fibrosis – 4 {FIB-4} index, King’s score, and platelet count/ spleen diameter {PC/SD ratio}) in detection of esophageal varices in patients with liver cirrhosis. Patients and Methods: This prospective cohort study included a total of 120 cirrhotic patients, attending at Hepatology Outpatient Clinic, Endoscopy Unit and Radiodiagnosis Department, El-Demerdash Hospital, Ain Shams University. Patients were classified according to presence of esophageal varices (EVs) detected by esophagogastroduodenoscopy (EGD) into two groups; Group 1 consisted of 9 patients with no EVs, and Group 2 consisted of 111 patients with EVs. group II were further subdivided according to the grade of esophageal varices (EVs) into three subgroups. The following noninvasive scores and indices were calculated for all patients: APRIscore, AAR, FIB-4 index, King’s score, and PC/SD ratio.Results: Among the five scores studied, AAR at a cut off value >0.88 showed the greatest sensitivity (86.49%) and accuracy (92.8 %), followed by PC/SD ratio at a cut off value <668.97 with an 86.49% sensitivity and 90.1% accuracy and FIB-4 index at a cut off value >5.1 with an 83.78% sensitivity and 90.1% accuracy. While the least sensitive scores were APRI and King’s score with a 70.27% and 67.57% sensitivity respectively. Conclusion: It could be concluded that AAR and PC/SD ratio are the most sensitive scores that can predict the presence of esophageal varices (EVs) in cirrhotic patients with acceptable accuracy. Being cheap and applicable they could be used as an initial screening tests to detect esophageal varices in patients with liver cirrhosis. | ||||
| Keywords | ||||
| Liver cirrhosis; Esophageal varices; Non-invasive scores; Non-invasive modalities | ||||
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