Prediction of esophageal varices in liver cirrhosis by transient elastography and aspartate aminotransferase - to - platelet ratio index (APRI)
Keywords:Liver cirrhosis, esophageal varices (EV), transient elastography, Aspartate aminotransferase-to-Platelet ratio index (APRI)
Background: Cirrhosis is a chronic liver disease that can be caused by almost all progressive liver injuries, such as viral, autoimmune, hereditary, metabolic and toxin mediated liver diseases. Esophageal varix (EV) is a frequent complication of cirrhosis. Although the survival rate of patients with bleeding cirrhosis has improved because of the progress in variceal hemorrhage management, the hospital mortality rate is still around 14.5% cases. Early detection of EV in all patients with liver cirrhosis is required in order to reduce the mortality.
Method: This observational study was done at department of Gastrointestinal, Hepatobiliary & Pancreatic Disorders (GHPD), BIRDEM General Hospital, Dhaka, during the period of August 2015 to October 2016. A total of 65 patients with cirrhosis of liver were included. Complete blood count, liver function test, endoscopy of upper GIT, ultrasonography, transient elastogram were done for all patients. Statistical analysis was done with SPSS version 22.
Result: The study included 65 cirrhotic patients, among them 66.2 % were male. The mean age was 53.8 years. For predicting EVs, transient elastography at a cutoff value of 18 kpa demonstrated a sensitivity was 88.7% (95% CI=82.3-92.7), specificity 75.0% (95% CI=46.9-92.6), PPV 94.0% (95% CI=87.2-98.2), NPV 60.0% (95% CI= 37.5 -74.0), AUC was 0.769. In APRI for prediction of EVs at cutoff value 1.00, sensitivity was 63.3% (95% CI=55.6-65.4), specificity 83.3.0% (95% CI=53.7-97.0), PPV 94.3% (95% CI=84.1-99.0), NPV 33.3% (95%CI=21.5-38.8) and AUC was 0.779.
Conclusion: A significant positive correlation found between transient elastography with EVs in cirrhotic patients. Liver stiffness value at 18 Kpa can predict EVs in cirrhotic patients. On contrary, APRI had a less(negative predictive value) NPV that showed there is no satisfactory cutoff value for APRI to be used as a predictor of EVs.
Bangladesh Crit Care J March 2018; 6(1): 16-21
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