EARLY PREDICTION OF ESOPHAGEAL VARICES ON THE BASIS OF ASPARTATE AMINO-TRANSFERASE (AST) TO PLATELET RATIO INDEX (APRI) AND TRANSIENT ELASTOGRAPHY IN PATIENTS OF CIRRHOSIS OF LIVER

Abstract

Objectives: To study the etiological prole in liver cirrhosis patients & to predict development of esophageal varices at the earliest with the help of Aspartate Amino-Transferase (AST) to Platelet ratio index (APRI) and Transient Elastography in these patients. The study wasMethods: conducted on 100 patients with chronic liver disease from June 2019 to June 2021. Informed consent was taken from the patients and detailed history, physical examination, laboratory investigations were carried out & UGI endoscopies were performed. APRI scores & Transient Elastography (broscan) liver stiffness measurement (LSM) values were then correlated with 'presence or absence' of esophageal varices (EVs) and with the 'grading' of varices. Among the 100 patients with liver cirrhosis, the overall prevalence of liver cirrhosis was higher in malesResults: (67.0%) than females (33.0%). The main cause of liver cirrhosis was alcoholic liver disease (39.0%) followed by chronic hepatitis B infection (15.0%). Different APRI cut-offs of 1.9, 1.4, 0.9 were taken & correlated with 'presence or absence' of EVs & with the 'grading' of EVs, but none shows satisfactory negative predictive value (NPV), proving that there is no satisfactory cut-off value of APRI to be used as a predictor of esophageal varices. However, as the APRI score is increasing, the grading of varices found on UGI endoscopy is increasing (r = 0.605, p<0.001). LSM cut-off values of 24KPa, 19KPa & 14KPa were taken & we observed NPV of 75.0% for predicting esophageal varices at LSM cutoff of 14 KPa. Also, as the LSM score is increasing, the grading of varices found on UGI endoscopy is increasing (r = 0.842, p<0.001). APRIConclusion: scores correlate poorly with the 'presence or absence' of esophageal varices but it correlate signicantly with the 'grading' of varices. Transient elastogram liver stiffness values correlate signicantly with the 'presence or absence' of esophageal varices & also with the 'grading' of varices. Liver stiffness value of ≥14.0 KPa can be used as a guide for early prediction of esophageal varices & endoscopy should be done in these patients to prevent fatal GI bleed from esophageal varices by medical management to decrease portal pressure or by early endotherapy in the form of endoscopic variceal ligation (EVL) or sclerotherapy.