Abstract
BackgroundDevelopment of esophageal varices (EVs) is the main complication of portal hypertension. Early detection prevents variceal bleeding. Baveno VI consensus recommended endoscopy if transient elastography (TE) > 20 kPa and platelets below 150,000/mm3.AimAssessment of the reliability of the albumin-bilirubin (ALBI), platelets-albumin-bilirubin (PALBI), albumin-bilirubin-platelets (ALBI-PLT) score, and gamma-glutamyl transferase-platelets (GAR) ratio as non-invasive models for prediction of EVs presence and the need for endoscopy in patients with HCV-related cirrhosis.MethodsHCV-related F4 fibrosis by TE or cirrhosis patients were included (n = 661). Full metabolic profile, CBC, ultrasonography, and endoscopy were done.ResultsThe average age was 42.89 years mainly males. Patients with EVs had statistically significant (p < 0.05) higher TE values, ALBI, ALBI-PLT, and PALBI than those without EVs. Both groups were comparable for GAR. Large varices were statistically (p < 0.05) associated with higher ALBI, ALBI-PLT, and PALBI. Both small and large varices had comparable TE and GAR. EVs detection cutoffs (sensitivity, specificity): TE > 20 kPa (83.64%, 91.62%), ALBI >− 2.43 (81.28%, 74.89%), ALBI-PLT > 3 (77.34%, 72.93%), and PALBI >− 2.28 (62.1%, 76.4%). On comparison of the ROCs, TE was better than ALBI (p < 0.05), ALBI-PLT, and PALBI. ALBI was better than ALBI-PLT and PALBI. Both ALBI-PLT and PALBI are comparable (p > 0.05). Positive indirect hemagglutination of schistosomiasis, portal vein diameter, splenic vein diameter, TE, ALBI, ALBI-PLT, and PALBI were independent predictors of EVs existence. On multivariate analysis, portal vein diameter, TE, and ALBI score were significant.ConclusionThe ALBI, ALBI-PLT, and PALBI are useful predictors of EVs presence and the need of diagnostic endoscopy especially in centers that lack FibroScan.
Highlights
Development of esophageal varices (EVs) is the main complication of portal hypertension
On comparison of the receiver operating characteristic (ROC), transient elastography (TE) was better than ALBI (p < 0.05), ALBI-PLT, and PALBI
ALBI was better than ALBI-PLT and PALBI
Summary
Development of esophageal varices (EVs) is the main complication of portal hypertension. Baveno VI consensus recommended endoscopy if transient elastography (TE) > 20 kPa and platelets below 150,000/mm. Portal hypertension (PHTN) is a pathological increased portal vein pressure. It is defined as hepatic venous pressure gradient (HVPG) > 5 mmHg [1]. The etiology may be prehepatic, e.g., portal vein thrombosis, intrahepatic, e.g., cirrhosis and post-hepatic, e.g., congestive. Liver cirrhosis is the most important cause of portal hypertension. There are several factors associated with pathogenesis of portal hypertension. There is increased intrahepatic vascular resistance to the portal flow due to sinusoidal capillarization as well as fibrosis-induced distortion of the vasculature.
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