Evaluation of the Sabadell noninvasive hepatitis C-related cirrhosis early detection index and right lobe diameter to albumin ratio in the prediction of presence of varices in Egyptian cirrhotic patients

Abstract

IntroductionPortal hypertension in cirrhosis results from progressive fibrotic remodeling of the liver, which increases the resistance to hepatic sinusoidal blood flow. Increased portal venous pressure causes esophageal and gastric varices, which contribute substantially to cirrhosis-related morbidity and mortality. The gold standard in the diagnosis of varices is esophagogastroduodenoscopy, but identification of noninvasive predictors of esophageal varices (OVs) will allow upper gastrointestinal tract endoscopy to be carried out only in a selected group of patients. Different noninvasive parameters including clinical, laboratory, and sonographic predictors are an alternative approach to perform selective screening endoscopy only in patients at high risk.ObjectiveOur objective is to evaluate whether the noninvasive hepatitis C-related cirrhosis early detection (NIHCED) score and the right lobe diameter to albumin ratio can predict the presence of OVs in a group of Egyptian cirrhotic patients.Patients and methodsSeventy-five patients with liver cirrhosis were enrolled in the study depending on the clinical evidence of stigmata of chronic liver disease (e.g. jaundice, ascites, palmar erythema, spider naevi, etc.) and ultrasonographic features of liver cirrhosis (e.g. coarse echo texture, shrunken liver, etc.).ResultsAccording to the esophagogastroduodenoscopy results, the patients were categorized into two groups: those with OVs (47 patients, 63%) and those without OVs (28 patients, 37%).Receiver operating characteristic curve analysis of the NIHCED score was applied to both groups with a cutoff score of more than 45. The estimation cohort study had a sensitivity of 70%, specificity of 78%, and diagnostic accuracy of 74% with an area under the receiver operating characteristic curve of 0.77 (95% confidence interval, 0.66–0.86).Receiver operating characteristic curve analysis of the right lobe diameter to albumin ratio was applied to both groups with a cutoff score of more than 2.80. The estimation cohort study had a sensitivity of 80%, specificity of 53%, and diagnostic accuracy of 67% with an area under the receiver operating characteristic curve of 0.67 (95% confidence interval, 0.55–0.77).ConclusionThe NIHCED score and right lobe diameter to albumin ratio are simple noninvasive predictors of the presence of varices in Egyptian patients with liver cirrhosis.