Assessment of Right Lobe Size/Serum Albumin Ratio as a Non-Invasive Marker for Esophageal Varices in HCV Patients

Abstract

Abstract Background Viral hepatitis was estimated to be the 7th leading cause of mortality globally. HCVassociated disease is one of the leading causes of HCC and the main indications for liver transplantation. Approximately 71 million people are chronically infected worldwide, with a total global HCV prevalence estimated at 2.5%. Egypt has the highest world prevalence of hepatitis C virus (HCV) infection, which is associated with substantial disease and economic burden. Chronic HCV infection can result in hepatic fibrosis, cirrhosis, HCC and death. One of the major complications of cirrhosis is gastroesophageal varices, the incidence of which ranges from 35% to 80%). Current guidelines recommend that all cirrhotic patients should undergo screening endoscopy at diagnosis to identify patients with varices at high risk of bleeding who will benefit from primary prophylaxis. Noninvasive identification of patients at highest risk for esophageal varices would limit investigation to those most likely to benefit. Aim of the Work The aim of our study is to determine the predictive value of noninvasive parameters (Rt. lobe diameter/ serum albumin ratio) in the prediction of esophageal varices. Patients and Methods It is a cross-sectional study carried on 100 patients collected from the Hepatology outpatient clinics and from Hepatology and Gastroenterology unit, Internal medicine department at Ain Shams University Hospital over 6-month period, with inclusion and exclusion criteria aiming at the elimination of other factors that might affect the study results. All patients were divided into 3 groups: 30 patients with Child-Pugh A, 30 patients with Child-Pugh B, and 40 patients with Child-Pugh C. patients were subjected to the following: Clinical assessment: including; Full medical history and clinical examination, laboratory investigations: (AST, ALT, Bilirubin, Albumin, INR, Alpha feto-protein, CBC), abdominal ultrasonography and doppler ultrasonography: performed after overnight fasting and the patient in supine position with emphasis on the liver right lobe diameter (cm), splenic bi-polar diameter (long axis) (cm), ascites, presence of periportal thickening, portal vein diameter (mm) and patency, upper GI endoscopy. Results Our study showed that regarding platelet count, INR, serum albumin, Liver size, liver size / serum albumin ratio there was a significant difference among esophageal varices grades. Liver size / serum albumin ratio had non-significant diagnostic performance in differentiating esophageal varices grade-I from grade-0, had significant moderate diagnostic performance in differentiating other esophageal varices grades from each other. Liver size / serum albumin ratio cutoff points had high specificity & PPV but low sensitivity& NPV in differentiating grade-I from grade-0, had high sensitivity& NPV but moderate specificity & PPV in differentiating other grades from each other. Conclusion Our study showed that there was significant moderate agreement between endoscopy and liver size / serum albumin ratio regarding esophageal varices grades. Our study stresses on the use of some of the non-invasive parameters in predicting the grade of esophageal varices in cirrhotic patients without submitting them to the invasive, time consuming and expensive procedure of endoscopy.