ABSTRACT
Introduction: Bleeding from esophageal varices causes significant mortality and morbidity in patients with chronic liver disease. With upper GI endoscopy not available in many centers and in rural India, certain noninvasive methods can help to aid in the prediction of the presence of large esophageal varices. Early identification of large varices helps in prophylaxis to prevent bleeding until definitive management is done. Here in this study, we are using platelet count/spleen diameter ratio in predicting the large esophageal varices and comparing its sensitivity and specificity with non-invasive parameters. Study: This is a cross-sectional study (Prospective study) in a tertiary hospital. Methods: Patients admitted to SSIMS & RC, DAVANAGERE between January 2021 and June 2021 with a diagnosis of chronic liver disease were included in the study. Patients were assessed for ascites, splenomegaly, ultrasonographic measurements like splenic size and portal vein diameter, and laboratory parameters like hemoglobin, platelet count, total bilirubin, prothrombin time and serum albumin. The ratio of platelet count with spleen diameter was calculated. Univariate and multivariate analyses were done. Results: Incidence of large varices were seen in 44%. By ultrasonography, 22 were found to have splenomegaly while 28 were found to have normal spleen dimensions. Patients with large esophageal varices had significantly lower platelet counts as compared to those without. Spleen diameter was greater while platelet count/spleen diameter ratio was lower in patients with large esophageal varices. On multivariate analysis, independent predictors for the presence of large varices were palpable spleen, low platelet count, spleen size >13.8 mm, portal vein >13 mm and splenic vein >11.5 mm. The platelet count/ spleen diameter ratio had a sensitivity and specificity of 87 % and 85% respectively which was more than other parameters. Hence platelet count/ spleen diameter ratio can be a reliable indicator for predicting the presence of large esophageal varices than other non-invasive parameters. Conclusion: Platelet count/ spleen diameter ratio is more accurate and a strong predictor of large esophageal varices than any other non-invasive parameters in patients with chronic liver disease which warrant the need for prophylaxis and early intervention to prevent life-threatening hemorrhage.
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Objective To evaluate the accuracy of different noninvasive methods for the diagnosis of nonalcoholic steatohepatitis(NASH) and hepatic fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) combined with type 2 diabetes mellitus(T2DM). Method A prospective comparative study was performed for 91 patients with T2DM and NAFLD, which were diagnosed by glucose tolerance test and liver biopsy. The height and body mass of the patient were measured, and the body mass index(BMI) was calculated. The fasting venous blood of the patient was collected, and then the blood routine, liver function and ferritin were measured. NPS, neutrophil lymphocyte ratio(NLR), BARD score, FIB-4 index, APRI, and NAFLD fibrosis score(NFS) were calculated. All patients underwent transient elastography (Fibrotouch) to evaluate the degree of liver stiffness measurement (LSM) and controlled attenuation parameter. All the liver biopsy specimens were categorized by SAF as the gold standard for evaluating NASH and liver fibrosis NASH. Correlation analysis was applied to compare the correlation between the noninvasive methods and SAF. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to assess the diagnostic value of the noninvasive methods for NASH and liver fibrosis NASH. Results In T2DM combine with NAFLD patients, NPS, LSM, NFS, APRI, FIB4 and BMI scores were positively correlated with SAF (r value was 0.509, 0.508, 0.252, 0.396, 0.313 and 0.213, respectively; P value was <0.001, <0.001, 0.016,<0.001, 0.003 and 0.043, respectively). LSM, NPS, NFS and FIB4 scores were positively correlated with liver fibrosis (r value was 0.535, 0.337, 0.315 and 0.315, respectively; P value was <0.001, 0.001, 0.002, 0.002, respectively). The ROC curve shows that the area under the curve of NPS, LSM, APRI, FIB4 and BMI for diagnosing NASH was 0.838, 0.760, 0.734, 0.623 and 0.682, respectively, and P value was 0.000, 0.000, 0.000, 0.044 and 0.003, respectively. For the diagnosis of fibrotic NASH, that value of LSM, NFS, FIB4 and NPS was 0.795, 0.765, 0.686 and 0.623, respectively, and P value was 0.000, 0.001, 0.020 and 0.123, respectively. Conclusions NPS, LSM and APRI have good clinical diagnostic value for NASH. LSM and NFS have good diagnostic value for fibrotic NASH.
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Objective: To study the predictive power of noninvasive investigative parameters (clinical, biochemical, radiological) for detection of esophageal varices in patients with portal hypertension (PHT) as compared to invasive parameters (upper gastrointestinal endoscopy). Materials and methods: Fifty patients with PHT, between May 2008 to September 2010, were studied. Those who had decompensated liver diseases, HIV, hepatocellular carcinoma, metastasis in liver, parentral drug addiction, chronic febrile illness, H/O treatment taken for PHT in the form of surgery or endoscopic bending or sclerotherapy were excluded. Detailed clinical history was taken and physical examination was done. All patients underwent the required hematological, biochemical, radiological, endoscopic and histopathological investigations. Results: Platelet count/splenic size showed a significant correlation between presence or absence and grade of esophageal varices (p < 0.00015). If a cut-off value of 1,000/cu mm is taken, then 87.5% (35/40) patients with esophageal varices have ratio <1,000 while 20% (2/10) of patients with ratio <1,000 did not have any varices. It was also observed that lower the ratio, higher the grade of varices. Conclusion: Asymptomatic esophageal varices, which is quite common, can be easily diagnosed with invasive endoscopy or otherwise can be suspected with noninvasive predictors like platelet/spleen size ratio in our country, where financial constraint is a major problem for investigations like endoscopy.