Abstract
BackgroundIn cirrhosis upper-gastrointestinal-endoscopy (UGIE) identifies oesophageal varices (OV). UGIE is unavailable in most resource-limited settings. Therefore, we assessed prediction of presence of OV using hematological parameters (HP) and Child-Turcott-Pugh (CTP) class.MethodsA prospective study was carried out on consecutive, consenting, newly-diagnosed patients with cirrhosis, in the University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka from April 2014–April 2016. All patients had UGIE to evaluate presence and degree of OV, prior to appropriate therapy. HP (full blood count with indices using automated analyzer and peripheral blood smear using Leishmann stain) and CTP class were assessed on admission. Linear logistic regression model was developed to predict OV using HP and CTP class.Results54-patients with cirrhosis were included [14(26%), 24(44%) and 16(30%) belonged to CTP class A, B and C respectively]. 37 had varices [CTP-A 4/14(26.6%), CTP-B 19/24(79.2%), CTP-C 14/16(87.5%)] on UGIE. Generalized linear model fitting showed decreasing percentage of small platelets (%SP) (P = 0.002), CTP-B (P = 0.003) and CTP-C (P = 0.003) compared to CTP-A had higher probability of having OV. The model predicts the log odds for having OV = − 0.189 – (0.046*%SP) + 2.9 [if CTP-B] + 3.7 [if CTP-C]. Based on receiver operating characteristic (ROC) analysis, a model value > − 0.19 was selected as the cutoff point to predict OV with 89%-sensitivity, 76%-specificity, 89%-positive predictive value and 76%-negative predictive value.ConclusionsWe constructed a model using %SP on peripheral blood smear and CTP class. This model may be used to predict the presence of OV, in newly diagnosed patients with cirrhosis, with acceptable sensitivity and specificity, to prioritize the patients who deserve early UGIE in limited resource settings.
Highlights
In cirrhosis upper-gastrointestinal-endoscopy (UGIE) identifies oesophageal varices (OV)
This will help to minimize the burden on emergency upper gastrointestinal endoscopy (UGIE) services, admissions to high-dependency units, use of expensive pharmacological agents, utilization of blood and blood product support and further decompensation of these patients resulting in prolong hospital stay
Twenty three patients were not included in the analysis because of multiple reasons such as death, defaulted follow up, long waiting list, being unable to have UGIE, missing blood films and having blood transfusions before collecting the sample for full blood count (FBC) and blood film
Summary
In cirrhosis upper-gastrointestinal-endoscopy (UGIE) identifies oesophageal varices (OV). Identifying patients with cirrhosis who are at risk of bleeding from OV is important to prevent overt bleeding, improve survival and minimize health care costs [2]. This will help to minimize the burden on emergency upper gastrointestinal endoscopy (UGIE) services, admissions to high-dependency units, use of expensive pharmacological agents, utilization of blood and blood product support and further decompensation of these patients resulting in prolong hospital stay. The aim of the UGIE screening is to identify those patients who are at increased risk of bleeding from OV and to select those who should receive primary preventive prophylactic treatment [non-selective β-block therapy or endoscopic variceal ligation (EVL)] [1, 2]
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