Abstract
Oesophageal variceal (OV) bleeding is a potentially fatal consequence of portal hypertension in patients with liver cirrhosis. Upper GI endoscopy is recommended for screening for varices in cirrhotics for early detection and treatment, however, this is invasive. The purpose of this study was to assess the predictive values of the noninvasive tests in detecting the presence of OV. A cross-sectional hospital-based study involving 149 patients with liver cirrhosis was carried out at the Korle-Bu Teaching Hospital from 1st November 2015 to 25th November 2016. Relevant clinical parameters assessed included Child-Pugh class, ascites and splenomegaly. Full blood count and liver function tests, abdominal ultrasound and gastroscopy were done for all the participants. Receiver operating characteristic curve was generated to determine the cut-off values for the best sensitivity, specificity, negative and positive predictive values of the variables (serum albumin, platelet count (PC), aspartate aminotransferase (AST)/alanine aminotransferase (ALT), PC/Spleen diameter( SD)) with regard to the presence of OV. On gastroscopy, 135 (90.60%) had OV and 14 patients (9.40%) had no OV. One hundred and eleven of the varices (82.22%) were large varices and the rest (17.78%) small varices. The overall mean of serum albumin, PC and PC/SD were not significant predictors of the presence of OV. However, the overall mean of AST/ALT significantly predicted the presence of OV. A PC/SD cut off value of ≤833.3 had 72.62% diagnostic accuracy for diagnosing all OV. PC/SD cut-off could be used to screen cirrhotics for OV and treatment initiated in geographical areas lacking endoscopy facilities. None declared.
Highlights
Oesophageal variceal (OV) bleeding is a potentially fatal consequence of portal hypertension in patients with liver cirrhosis
One hundred and forty-nine patients with liver cirrhosis were included in this study
PC/spleen diameter (SD) was not calculated for 3 patients because platelet count and spleen size were not done for 2 and 1 patients respectively
Summary
Oesophageal variceal (OV) bleeding is a potentially fatal consequence of portal hypertension in patients with liver cirrhosis. Varices are present in 40%and 60% of patients with clinically compensated and decompensated chronic liver disease respectively.[1] Over the course of their disease, 90% of cirrhotics will develop oesophageal varices.[2] Variceal bleeding accounts for 80% to 90% of bleeding episodes in cirrhotic patients and oesophageal varices have a 25-35% risk of bleeding.[4,5,6] Bleeding caused by rupture of OV is associated with a high mortality rate of 30%,3and is a qualifying criteria for liver transplantation. The poor outcome of variceal bleeding makes identification of those at high risk and prevention of a first bleeding episode critically important.[7]
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