32 LOW SERUM CHOLINESTERASE LEVELS-CAN DIFFERENTIATE BETWEEN WELL COMPENSATED AND DECOMPENSATED CIRRHOSIS

Abstract

S 20TH ANNUAL CONFERENCE OF INASL, MARCH 2–4, 2012 S20 © 2012, INASL A b tra ts 32 LOW SERUM CHOLINESTERASE LEVELS— CAN DIFFERENTIATE BETWEEN WELL COMPENSATED AND DECOMPENSATED CIRRHOSIS J Ramachandran1, KG Sajith1, S Priya2, AK Dutta3, KA Balasubramanian2 Department of Hepatology, 2Wellcome Research Laboratory, 3GI Sciences, Christian Medical College, Vellore, India Background: Serum cholinesterase (ChE) is produced by the liver, and its activity is related to the synthetic function of liver. Low serum levels might provide prognostic information in chronic liver disease (CLD). Aim: (i) To estimate the values of ChE in patients with cirrhosis of varying severity, (ii) to study if serum ChE levels are different between compensated and decompensated cirrhosis, and (iii) to correlate between serum bilirubin, albumin, aspartate aminotransferase (AST), model for endstage liver disease (MELD) score, prothrombin time (PT) and ChE. Materials and Method: Consecutive patients diagnosed to have cirrhosis based on liver biopsy or ultrasonogram were studied prospectively. The ChE levels were measured by calorimetric method. Presence of jaundice, ascites, encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome, variceal bleed, and hepatocellular carcinoma was defined as decompensated chronic liver disease (DCLD). The ChE levels were compared (Mann-Whitney’s test), and receiver operating characteristics (ROC) curve was drawn to find an optimal cut-off level between the two groups. Levels were also correlated with serum bilirubin, albumin, PT international normalized ratio (INR) and MELD score by Spearman’s test. Result: A total of 178 patients (35 women and 143 men) were studied. Their median age was 46 (7–77) years. The ChE levels ranged from 110 to 8143, with a median of 1590 IU/L. Whereas 123 patients had DCLD, 53 had compensated disease. Median ChE level in compensated CLD was 4081 IU/L (680–8143) and 1287 IU/L (110–4412) in DCLD (P < 0.01); ChE levels <1800 IU/L had 80% sensitivity and 80% specificity in predicting DCLD (area under ROC curve = 0.9, 95% CI = 0.848–0.961). The AUC for MELD to predict DCLD was 0.87, 95% CI 0.82–0.92. The correlation coefficient between ChE and other markers was 0.67 for serum albumin, 0.59 for MELD score, 0.53 for PT INR, 0.32 for AST, and 0.47 for serum bilirubin. Conclusion: The ChE estimation, a simple and inexpensive biochemical test, was as good as MELD score in predicting clinically significant decompensation in this cohort of patients with CLD. 31 A STUDY ON USEFULNESS OF RENAL ARTERY RESISTIVE INDEX AS A NONINVASIVE PREDICTOR OF VARICES AND BLEED IN CIRRHOSIS WITH PORTAL HYPERTENSION L Thayumanavan, S Vasudevan, R Rathinam, K Mariappan, J Pudusery, H Hercule, P Theophilus Department of Gastroenterology, Madurai Medical College, Madurai Background: Bleeding varices has high mortality in cirrhosis. Endoscopy is invasive and is disliked by patients. Non-invasive markers predicting varices, such as portal vein size, platelet count, splenomegaly and platelet count/ splenic diameter ratio are already in vogue. Renal artery resistive index (RIR) is a new non-invasive predictor of the presence of varices and bleeding risk. Usefulness of RIR in predicting the presence of varices and bleeding in cirrhotics was studied. Aim: To study RIR as a non-invasive marker to predict varices and bleeding and to compare our study with published literature. Method: Fifty cirrhotics attending Government Rajaji Hospital, Madurai were included. All patients underwent endoscopy and routine investigations. Renal Doppler measurements to determine RIR were done. Epi Info statistical analyzing software was used for analysis. Result: Fifty cirrhotics, 34 males and 16 females aged between 27 and 60 years (mean 43.84) formed the study population. Thirty-five out of 50 were alcoholics. Big varices were seen in 34/50. The mean RIR was 0.71 with standard deviation (SD) of 0.063 with control (0.62 ± 0.05). About 76% (75.60%) having RIR of ≥0.67 had grade 2 and 3 varices. About 66.7% having RIR < 0.67 had grade 1 or no varices (P < 0.05). There were 7 Childs A cirrhotics, 30 Childs B and 13 Childs C. In Childs A, mean RIR was 0.62 (SD 0.087). In Childs B mean RIR was 0.693 (SD 0.043), and in Childs C mean RIR was 0.757 (SD 0.034) (P < 0.01). Sixty percent of patients with RIR ≥0.67 had an upper gastrointestinal (UGI) bleeding episode. Twenty percent of patients with RIR <0.67 had UGI bleed (P < 0.05). Conclusion: (i) RIR was higher in cirrhotics when compared to controls, (ii) RIR was higher in Childs C cirrhosis indicating severity, (iii) high RIR correlated directly with the size of the varices, and (iv) a higher RIR is associated with increased UGI bleed. The results obtained are comparable to the published results in various scientific journals. 002-JCEH-Abstract.indd S20 2/13/2012 1:26:30 PM