Left liver lobe diameter albumin ratio as a predictor of esophageal varices in patients with cirrhosis: A preliminary report

Abstract

Abstract Objective: The aim of this study was to determine the significance of the ratio of diameter of left lobe of liver with serum albumin as a non-invasive predictor of esophageal varices. Materials and Methods: All consecutive patients with clinical cirrhosis were included in the study. The study was conducted in the Department of Gastroenterology and Hepatology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan. All patients underwent full history taking, clinical examination, relevant laboratory investigations and abdominal ultrasound evaluation. Measurement of the right liver lobe diameter (RLLD) and left liver lobe diameter (LLLD) was performed using ultrasound in the mid-clavicular line and central line, respectively. Esophago-gastroscopy was performed for the detection and grading of esophageal varices. Calculation of the RLLD and LLLD/serum albumin ratio was performed and analyzed for clinical significance. Results: One hundred and eleven subjects (80 males; 72%), with a mean age of 40.09 ± 13.6 years were studied. Esophageal varices were seen in 68 (61.3%) patients and Child-Pugh class A accounted for 41.4%, class B for 45.9% and class C for 12.6% cases. The mean value of RLLD/serum albumin ratio was 5.05 ± 1.90 in patients with varices versus 4.24 ± 1.64 in patients without varices (P = 0.023). The mean value of the LLLD/serum albumin ratio was 2.41 ± 0.90 in patients with varices versus 1.89 ± 0.61 in patients without varices (P < 0.001). Areas under curve were 0.377 and 0.69 for the RLLD/ serum albumin ratio and LLLD/serum albumin ratio, respectively. At a cut-off value of 1.5, the sensitivity was 88.1% and the specificity was 72.1% for the LLLD/albumin ratio. Conclusion: The LLLD/albumin ratio is a better predictor of esophageal varices than the RLLD/albumin ratio in patients with liver cirrhosis.