Correlation of Liver Elastography as a Predictor of Esophageal Varices and Its Comparison With Ultrasound Abdomen and Liver Function Tests in Patients With Chronic Liver Disease.

Abstract

Variceal haemorrhage is a life-threatening complication that occurs in up to 40% of patients with chronic liver disease including cirrhosis. It is associated with a mortality rate of 20%with each episode of variceal bleeding. Esophagogastroduodenoscopy is the gold standard for the detection of esophageal varices but is an invasive procedure and not verycost-effective. Our study was designed to correlate the presence of esophageal varices on endoscopywith the liver stiffness measurement using liver elastography inpatients with chronic liver disease. We also comparedvarious non-invasive predictors like laboratory parameters and ultrasound features andcorrelated them with the presence of varices inpatients with chronic liver disease. This prospective observational study was conducted ina tertiary-care hospital in South Indiafrom November 2017 to April 2019.All patients withchronic liver disease were subjected to endoscopy, and the presence ofesophageal varicesand their grading was noted. The predictive efficacy of ultrasound elastographyusing Toshiba Aplio 500 ultrasound two-dimensional shear wave elastography (2D-SWE) in predicting esophageal varices was calculated and compared with the efficacy of predictingesophageal varices by other non-invasive parameters like laboratory investigations, abdominal ultrasound, and liver scores like Child-Turcotte-Pugh (CTP) score, model for end-stage liver disease (MELD) score, fibrosis 4 (FIB-4) score,aspartate aminotransferase-to-platelet ratio index (APRI) score, andaspartate aminotransferase/alanine aminotransferase ratio (AAR). The study includeda total of 168 patients out ofwhich 57% (96 patients) had no varices. About 52 patients(72.2%) had F1/Grade I varices,9(12.5%) had F2/Grade II varices, and 11 (15.3%) had F3/Grade III varices. The greatest predictive value for esophageal variceswas liver stiffness with a diagnostic accuracy of 81.7%.Ultrasound features likecoarse echotexture of the liver (66.7%), splenomegaly (67%), dilated portal vein (78.6%), and presence of moderate ascites (66.7%) had asignificantstatistical association with the presence of esophageal varices. Laboratory parameters like thrombocytopeniaof less than 1.5 lakhs/cu.mm (52.8%), albumin <3 g/dL (60.4%), and reversal of albumin/globulin ratio(52.4%) weresignificant predictors of esophageal varices. The odds ratio for significant scores in predicting oesophageal varices using binary logistic regression was significant in patients whose liver elastography grade wasmore than F4, CTP score was B, MELD score was >11, and FIB-4 scoreswas >3.25 and between 1.46 and 3.25. Liver elastography is a non-invasiveprocedure that can be a useful tool in predicting esophageal varices in chronic liver disease. Other non-invasive predictorslike ultrasound abdomen and laboratory parameters canalso be considered a replacement for repeatedinvasive endoscopy, thusfacilitating early intervention and avoiding unfavourable outcomes in patients withchronic liver disease.