Abstract
Background: Esophageal varices occur at middle to advanced stages of cirrhosis and are associated with increased mortality due to their potential for rupture and bleeding. The aim of this study is to examine the accuracy of a surrogate marker, Mac-2 binding protein glycosylation isomer (M2BPGi), for screening high-risk esophageal varices in cirrhotic patients. Methods: Ninety-four cirrhotic patients who underwent endoscopy screening at Cipto Mangunkusumo Hospital, Jakarta, Indonesia were included. Patients with a history of ligation, portal vein thrombosis, or hepatocellular carcinoma were excluded. All enrolled patients underwent ultrasonography, transient elastography, and laboratory tests. The HISCL-5000 Sysmex analyzer was used to measure M2BPGi levels. Results: Of these 94 patients, 27 had high-risk esophageal varices and 67 had non-high-risk esophageal varices. M2BPGi levels were higher in patients with high-risk esophageal varices compared with those with non-high-risk esophageal varices (cutoff index (COI) of 11.4 vs. 3.7, p < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of M2BPGi with a cutoff value of 5 COI was 92.6%, 70.1%, 55.6%, and 95.9%, respectively. Conclusions: M2BPGi could be used as a non-invasive surrogate marker for ruling out high-risk esophageal varices in cirrhotic patients. This method is cheap and non-invasive and could be used as a screening tool in resource-limited settings.
Highlights
According to a 2020 Global Burden of Disease study, cirrhosis is ranked 16th in disability-adjusted life-years and has resulted in 1.32 million total deaths, with 0.44 million and 0.88 million deaths in females and males, respectively, in 2017 [1,2]
Portal hypertension is a complication of cirrhosis and esophageal variceal bleeding occurs at a portal pressure of >12 mmHg [3]
The aim of this study is to examine the performance of Mac-2 binding protein glycosylation isomer (M2BPGi) in detecting high-risk esophageal varices in cirrhotic patients
Summary
According to a 2020 Global Burden of Disease study, cirrhosis is ranked 16th in disability-adjusted life-years and has resulted in 1.32 million total deaths, with 0.44 million and 0.88 million deaths in females and males, respectively, in 2017 [1,2]. The gold standard for detecting esophageal varices is esophagogastroduodenoscopy This method is invasive and expensive, making it impractical for use in resource-limited settings. Another test method used is transient elastography. It has moderate accuracy and has a high rate of failure in obese patients, patients with ascites, and patients with narrow intercostal spaces [5,6,7,8]. The aim of this study is to examine the accuracy of a surrogate marker, Mac-2 binding protein glycosylation isomer (M2BPGi), for screening high-risk esophageal varices in cirrhotic patients. Results: Of these 94 patients, 27 had high-risk esophageal varices and 67 had non-high-risk esophageal varices
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