Abstract
Variceal size has been identified to be closely related to variceal bleeding. Repeated endoscopic examinations have a great burden on endoscopic units and cost-implication issues. Our aim was to evaluate the role of AST to platelet ratio index (APRI) in predicting the existence of large esophageal varices (EV) in hepatitis C virus-related liver cirrhotic patients. Seventy four patients with liver cirrhosis were prospectively recruited. Laboratory data, CTP, MELD and APRI, also ultrasonographic and endoscopic findings are performed and investigated whether associated with the size and bleeding of EV. Patients were divided into two groups; group 1 with small varices and group 2 with large varices. Group 2 had significantly prolonged prothrombin time, splenomegaly, ascites, higher Child score compared to group 1. CTP was associated with variceal bleeding (P = 0.028). While APRI was a poor predictor both for the presence of LVs and bleeding yet it revealed favorable results with bleeding EVs in patients with HCC with AUC (0.61). APRI was a good predictor for the presence of HCC and number of focal lesions with AURC (0.651, 0.61 respectively). Splenomegaly, CTP, ascites could be used as noninvasive predictors for large EVs. However, at the moment, these tests could not substitute for endoscopy. Although APRI is a poor predictor for the size and bleeding of EV, yet it might have a role in prediction of HCC and number of focal lesions.
Highlights
Variceal hemorrhage is the most dreaded complication in liver cirrhosis and may lead to life-threatening bleeding, in the case of large esophageal varices (LEVs) [1,2].The standard diagnostic tool for esophageal varices (EV) is endoscopy [3]
According to the result of the upper GI endoscopy, patients were classified into two groups according to the size of EVs: group 1 included 32 patients with small varices (SVs) and group 2 included 42 patients with large varices
When the receiver operating characteristic (ROC) curve was ascertained we found that an AST to platelet ratio index (APRI) cutoff of 1.4 was better positive than negative in the prediction of more than three focal lesions if the actual value was greater than the cutoff value and of less than three lesions if the value was less than the cutoff value, at an Area under the curve (AUC) of 0.61 (Table 6)
Summary
Variceal hemorrhage is the most dreaded complication in liver cirrhosis and may lead to life-threatening bleeding, in the case of large esophageal varices (LEVs) [1,2].The standard diagnostic tool for esophageal varices (EV) is endoscopy [3]. The aim of this study was to determine the ability of APRI in predicting the existence of LEVs in hepatitis C virus (HCV)-related liver cirrhotic patients. It was approved by the ethical committee of the Faculty of Medicine, Cairo University. Seventy-four patients were included in this prospective study. The included patients were above 18 years of age with HCV-related liver cirrhosis based on clinical, biochemical, and ultrasonographic findings. Our aim was to evaluate the role of AST to platelet ratio index (APRI) in predicting the existence of large esophageal varices (EV) in hepatitis C virus-related liver cirrhotic patients. Laboratory data, CTP, MELD and APRI, ultrasonographic and endoscopic findings are performed and investigated whether associated with the size and bleeding of EV
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