Assessment of Right Liver Lobe Size / Serum Albumin Ratio as a New Non-Invasive Predictor for the Presence of Oesophageal Varices in Egyptian Patients with HCV Related Liver Cirrhosis

Abstract

Background: Oesophageal varices are the most critical porto-systemic shunts that develop secondary to portal hypertension, which is considered the main complication of liver cirrhosis. Many studies recommend the screening of all cirrhotic patients by endoscopy, but repeated endoscopic examinations are unpleasant for patients and have a high- cost impact and burden on endoscopic units. Objective: This study aimed to evaluate the accuracy of using the right liver lobe size/serum albumin ratio as a non-invasive predictor of esophageal varices in patients with HCV-related liver cirrhosis. Patients Methods: This prospective study included 30 patients with liver cirrhosis and 30 patients who underwent upper gastrointestinal endoscopy for any causes other than liver cirrhosis. All studied subjects underwent a detailed history and clinical examination, biochemical workup, upper gastrointestinal endoscopy, and abdominal ultrasound. The right liver lobe/serum albumin ratio was calculated for all patients. Results: There was a statistically significant difference between the control and the study subgroups as regards the Right lobe of the Liver/Albumin ratio (p-value 0.007). The diagnostic accuracy of the Right lobe of the Liver/Albumin ratio was assessed using the ROC curve which revealed a sensitivity of 86.67% and specificity of 73.33% at cut-off value >3.88, with an acceptable discriminative accuracy of 79.9%. Conclusion: The use of Right liver lobe/serum albumin ratio can help physicians by restricting the use of endoscopic screening only to patients presenting a high probability of esophageal varices. This is especially useful in clinical settings where resources are limited, and endoscopic facilities are not present in all areas.