Esophageal Varices In Patients Research Articles

Splenic vein velocity is a good predictor of oesophageal varices in patients with Clinically Significant Portal Hypertension

Splenic vein velocity is a good predictor of oesophageal varices in patients with Clinically Significant Portal Hypertension

A study of non-invasive predictors of esophageal varices in patients with cirrhosis of liver – A cross-sectional study

Background: Current guidelines advise that patients diagnosed with liver cirrhosis undergo screening through upper gastrointestinal endoscopy to detect esophageal varices (EV). Prophylactic measures should be taken for those with large varices on diagnosis and during follow-up. However, this poses a dual challenge, both social and medical, as the number of cirrhotic patients rises while the availability of endoscopy units remains limited. Aims and Objectives: In this study, we aim to evaluate the diagnostic accuracy of the non-invasive predictors such as spleen size, platelet count (PC), and PC/spleen diameter (PC/SD) ratio for the diagnosis of EV. Materials and Methods: This hospital-based prospective observational study was done in the SDM College of Medical Sciences and Hospital, Dharwad, among 50 patients with cirrhosis of liver. Results: Among the 50 patients studied males pre-dominated the study with 80%. Out of the study population, 70% of the patients had varices. For a cutoff point of PC/SD ratio 916, the sensitivity was 71.42% and specificity was 93.3%. For a cutoff value of PC of 1.32 lakhs, the sensitivity was 71.42%, and the specificity was 73.3%. For a cutoff value of the longest SD of 12.40 cm, the sensitivity was 94.30%, and specificity was 33.3%. Conclusion: These non-invasive predictors can be useful screening tools for the diagnosis of EV. These can be effective for the initiation of prophylactic treatment when the endoscopy facility is not available.

Gastric variceal obstruction improves the efficacy of endoscopic management of esophageal variceal bleeding in GOV type I.

Background and study aims Limited data exist regarding endoscopic obstruction of type I gastroesophageal (GOV I) in managing bleeding from esophageal varices. In this multicenter retrospective cohort study, we aimed to access the efficacy of blocking gastric varices in management of bleeding from esophageal varices in patients with GOV1. Patients and methods Cirrhotic patients experiencing bleeding from esophageal varices and having GOV I gastric varices in four centers were screened. All included patients were followed up for 180 days, or until death. Results A total of 93 cirrhotic patients with GOV I and bleeding esophageal varices were included. Among them, 58 patients underwent endoscopic cyanoacrylate injection (ECI) for gastric varices in addition to treatment for esophageal varices (EV), while the remaining 35 patients received treatment for EV only. Kaplan-Meier analysis demonstrated that the cumulative 180-day rebleeding rate was significantly lower in the ECI plus EV treatment group (7.9%) compared with the EV treatment group (30.7%) ( P = 0.0031). The cumulative incidence of 180-day mortality was 1.9% in the ECI plus EV treatment group and 23.9% in the EV treatment group ( P = 0.0010). Multivariable Cox regression analysis revealed that concomitant ECI treatment was an independent protective factor against 180-day rebleeding and overall mortality. Conclusions In conclusion, obstruction of gastric varices in addition to endoscopic treatment for bleeding from esophageal varices in patients with GOV 1 proved superior to endoscopic treatment alone for esophageal variceal bleeding.

The Relationship between Periostin Level and the Presence of Esophageal Varices in Patients with Decompensated Cirrhosis

The Relationship between Periostin Level and the Presence of Esophageal Varices in Patients with Decompensated Cirrhosis

Correlation of Portal Hypertensive Gastropathy with the Size of Esophageal Varices in Patients with Decompensated Chronic Liver Disease:

Objectives: To determine the correlation of portal hypertensive gastropathy with esophageal variceal size. To determine the differences in gender of esophageal varices Study design: A cross-sectional study was done from January 2022- October 2022 on 440 patients reporting to JPMC, Karachi having portal hypertensive gastropathy and were assessed for severity of esophageal varices based on endoscopic findings. Methodology: The new Italian Endoscopic Club criterion was used for portal hypertensive gastropathy (PHG) and the Japanese Research Society for Portal Hypertensive Gastropathy to describe the grading of esophageal varices. Results: Of 440 patients 163 (37%) were female and 277 (63%) were males. The size of esophageal varices correlated with severity and a Spearman p<0.1% was seen which is significant. Male patients showed a significantly higher chance of having larger-sized varices. Conclusions: The size of varices correlates to severe decompensated chronic liver diseases (DCLD). Hence, patients with advanced liver cirrhosis are likely to be at risk of severe upper GI bleeds

Application of a virtual ruler in predicting postoperative rebleeding from esophageal varices in patients with liver cirrhosis

BackgroundEsophageal variceal diameter (EVD) is one of the most important predictors of variceal bleeding, as well as an important predictor of the effectiveness of endoscopic esophageal varices (EV) treatments. EVD is currently determined using visual inspection by endoscopic operators, meaning that results can vary widely between operators. This approach also means that cases unsuitable for endoscopic variceal ligation (EVL) can be complicated by postoperative hemorrhage. Thus, the purpose of this study was to explore the value of a virtual ruler (VR) in predicting rebleeding after the endoscopic treatment of EV in patients with cirrhosis. MethodsWe enrolled 588 patients with cirrhosis and EV (with and without gastric varices), who were treated with EVL or endoscopic injection sclerotherapy across 3 hospitals. We categorized participants into 2 groups, a nonbleeding group and a rebleeding group, according to whether they bled again after surgery. We compared basic demographic and clinical data, laboratory tests, EVD, and treatment modalities between the 2 groups. Potential risk factors for rebleeding after EV operations were analyzed using univariate and multivariable regression analyses. Correlations between esophageal variceal rebleeding and EVD were also analyzed, as was the consistency between visual EVD estimates and EVD measured using a VR. ResultsChild-Pugh class, albumin (ALB) levels, prothrombin time (PT), EVD (visual value), EVD (VR value), red sign, and the number of laps used for EVL showed statistically significant differences between the rebleeding and nonbleeding groups. Univariate regression analysis showed that Child-Pugh classification, ALB levels, PT, EVD (VR value), and red sign were strongly associated with rebleeding after endoscopic treatment of EV, whereas multivariable regression analysis showed that Child-Pugh classification, ALB levels, and EVD (VR value) were predictive factors for rebleeding after endoscopic treatment of EV. Differences between visual EVD estimates and VR EVD measurements were large. (Kappa value: 0.391, P < .001). However, the 2 methods showed high agreement for EVD >1 cm (87/95) ConclusionEVD (VR value) can more accurately predict rebleeding rates. It can also provide a basis for selecting appropriate endoscopic treatment modalities for EV and effectively circumvent postoperative EV rebleeding.

SAT-068 Accuracy of spleen stiffness measurement for the diagnosis of high-risk esophageal varices in patients with advanced chronic liver disease: a systematic review and individual patient data meta-analysis

SAT-068 Accuracy of spleen stiffness measurement for the diagnosis of high-risk esophageal varices in patients with advanced chronic liver disease: a systematic review and individual patient data meta-analysis

Platelet Count to Prothrombin Time: A Noninvasive Predictor of Esophageal Varices in Patients With Chronic Liver Disease.

Introduction Esophageal variceal bleeding is a potentially deadly consequence of portal hypertension in patients with cirrhosis. Although upper gastrointestinal endoscopy is still the preferred method for identifying esophageal varices (EV), the present study measured the platelet count to prothrombin time (PLT/PT) ratio for the assessment of portal hypertension and subsequent diagnosis of EVs in patients with chronic liver disease (CLD). Methods This was an observationalcomparative study conducted in the outpatient department of Patel Hospital, Karachi, Pakistan, using a non-probability consecutive sampling technique. Ethical approval was obtained from the Patel Hospital ethical review committee (PH/IRB/2022/028). An independent sample t-test was used for parametric data, whereas the Mann-Whitney U test was used for non-parametric data. The chi-square test was used to compare the categorical data of patients with and without EV. Receiver operating characteristic (ROC) analysis was performed to evaluate the cutoff values for the PLT/PT ratio, sensitivity, specificity, and area under the curve (AUC). Results The study involved 105 patients with and without EV. Among them, 38 (63.3%) males and 22 (36.7%) females had EV, whereas 30 (66.7%) males and 15 (33.3%) females did not. The platelet (PLT) count was also significantly lower in patients with EV (87.6 ± 59.8) than in those without (176.6 ± 87.7) (p < 0.001). The PLT/PT ratio was significantly lower in patients with EV (median: 5.04, IQR: 3.12-9.21) compared to those without (median: 14.57, IQR: 8.08-20.58) (p < 0.001). The sensitivity and specificity of the PLT/PT ratio for identifying EVs were 97.80% and 83.30%, respectively. Conclusion We found a significantly lower PLT/PT ratio in cases with EV than those without EV. After defining an optimal cutoff, PLT/PT had a high sensitivity in identifying cases with EVs in CLD. Therefore, we conclude that in patients with CLD, the PLT/PT ratio is a noninvasive predictor for the presence of EV.

Thrombocytopenia and Grading of Esophageal Varices in Patients With Chronic Liver Disease.

Background Chronic liver disease (CLD) is associated with a variety of consequences, including thrombocytopenia and esophageal varices, which significantly impact patient prognosis and management. Thrombocytopenia, frequently observed in patients with CLD, may correlate with the severity of esophageal varices, a critical complication leading to variceal bleeding. Methodology A cross-sectional study was carried out in the Department of Medicine and Gastroenterology, Pak Emirates Military Hospital, Rawalpindi, from October 2021 to March 2022. The study enrolled 94 patients, aged 18-70 years, diagnosed with CLD, regardless of the cause. These patients were categorized into four groups based on platelet count: <50,000/uL, 50,000-99,999/uL, 100,000-150,000/uL, and >150,000/uL. Pearson's correlation was utilized to evaluate the association between the severity of thrombocytopenia and the grading of esophageal varices. Results A total of 94 patients were enrolled in the study, with 53 (56.4%) males and 41 (43.6%) females. The mean age of patients was 51.06 ±11.09 years. Seventeen (18.1%) had no esophageal varices, 16 (17.0%) were diagnosed with Grade I varices, 35 (37.2%) with Grade II varices, and 26 (27.7%) had Grade III varices. Most patients without varices had a platelet count above 150 x 103 (17, 18.1%). Conversely, most patients with Grade III varices (19, 20.2%) had platelet counts below 50 x 103. Patients with no esophageal varices had a mean platelet count of 173.70 ± 37.48 x 103. Among the patients, those with Grade III esophageal varices exhibited the lowest mean platelet count, recorded at 78.54 ± 24.14 x 103. These findings indicate a statistically significant difference in mean platelet counts across the various esophageal varices grades (P = 0.000). There was an inverse correlation of platelet count with the grading of esophageal varices (r= -0.645, P < 0.000). Conclusions Anegative correlation was observed between the platelet count and the grading of esophageal varices, implying that as the severity of esophageal varices increased, the platelet counts proportionally decreased.

Tissue inhibitor of matrix metalloprotinase-1 and collagen type IV in HCV-associated cirrhosis and grading of esophageal varices

BackgroundEsophageal varices are abnormally dilated submucosal veins of the esophagus which develop as a result of portal hypertension due to cirrhosis. Collagen type IV is upregulated with a 14-fold increase in cirrhosis. Tissue inhibitor of metalloproteinases-1 (TIMP-1) is also upregulated during hepatic fibrogenesis and considered to promote fibrosis in the injured liver. The objective of this research was to study the serum levels of tissue inhibitor of matrix metalloprotinase-1 and serum collagen type IV in patients with post hepatitis C cirrhosis and their relation to the different grades of esophageal varices.Patients and methodsThis study was carried out on one hundred and twenty individuals classified into three groups: Group I included thirty patients with liver cirrhosis without esophageal varices. Group II included sixty patients with liver cirrhosis with esophageal varices. Group III included thirty healthy volunteers as controls.ResultsA significant positive correlation was found between collagen type IV and the presence of esophageal varices in esophageal varices group (p = 0001*). Also, a significant positive correlation was found between TIMP-1 and the presence of esophageal varices in esophageal varices group (p = 0.033*). After conducting multivariate logistic regression analysis, collagen type IV and INR were found to be independent risk factors for esophageal varices in patients with cirrhosis.ConclusionThe serum collagen type IV and TIMP-1 levels are useful markers for predicting of presence of esophageal varices.

Studying the effects of stress, mental health and psychological well‐being on wound healing rates after oesophageal varices ligation in liver cirrhosis patients

AbstractIt is of utmost importance to comprehend the impact that psychological factors have on physical rehabilitation, specifically in regards to wound healing following ligation of oesophageal varices in patients with liver cirrhosis. The present study investigated the correlation between wound recovery rates and psychological well‐being, stress and mental health. From January 2022 to September 2023, 148 patients from were evaluated as part of this cross‐sectional observational study. The psychological well‐being of participants was evaluated utilizing the Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS) and Psychological General Well‐Being Index (PGWBI). The rates of wound recovery were assessed following ligation. The mean duration for wound recovery was 28.37 ± 9.65 days. The mean wounds healing time of patients who obtained higher PSS scores (18.55) was marginally longer. On the contrary, there was a moderate reduction in healing time associated with higher HADS scores (mean 14.10). On average (68.88), PGWBI scores indicated a negligible effect on wound healing. The variance in healing durations between Child‐Pugh classifications A, B and C (mean values of 28.65, 26.90 and 29.57 days respectively) suggested that the severity of liver disease has an impact. As a result of ligation of oesophageal varices, the study demonstrated that psychological factors and wound recovery in patients with liver cirrhosis are intricately intertwined. There seems to be the substantial and intricate relationship between stress, mental health and wound recovery. The results of this study supported the notion that psychological evaluation and support should be incorporated into the management of patients with liver cirrhosis.

Utility of P²MS Index in Predicting Esophageal Varices in Patients with Hepatitis C Associated Chronic Liver Disease in Pakistani Population

Background: Screening for esophageal varices (EVs) in patients with chronic liver disease is critical for identifying those needing primary prophylaxis against variceal bleeding. The gold standard for EV screening is endoscopy, an invasive and costly procedure often avoided by patients. This necessitates the need for non-invasive predictive tools for the presence of EVs and high-risk varices (HRVs). The P²MS index, a relatively new model, has shown promise in this regard. Objective: This study aimed to evaluate the effectiveness of the P²MS index, alongside APRI and FIB-4 scores, in predicting the presence of EVs and HRVs in patients with hepatitis C-related chronic liver disease. Methods: Conducted at the Sindh Institute of Urology and Transplantation's Hepato-Gastroenterology department, this cross-sectional study involved 375 participants aged 18-50 years, recently diagnosed with liver cirrhosis due to hepatitis C. Excluding those with varied medical backgrounds, the study used non-probability consecutive sampling. Diagnostic procedures included esophagogastroduodenoscopy (EGD) and complete blood count. P²MS index, APRI, and FIB-4 scores were calculated for each participant. Data analysis was performed using SPSS version 25.0, focusing on the Area Under the Receiver Operating Curve (AUROC) to assess diagnostic accuracy. Results: In our population, the P²MS index at a cutoff of &lt;10.7 showed a specificity of 93.22% and sensitivity of 87.88% for predicting the presence of EVs, with a PPV and diagnostic accuracy exceeding 90%. For HRVs, a cutoff of &lt;5.4 demonstrated an excellent NPV, alongside good sensitivity, specificity, and diagnostic accuracy. Compared to APRI and FIB-4, the P²MS index had the highest AUROC for predicting the presence of EVs (0.92, 95% CI 0.89-0.95, p&lt;0.001). For HRVs, it was comparable to APRI (AUROC=0.88, 95% CI 0.85-0.92, p&lt;0.01) and superior to FIB-4. Conclusion: The P²MS index is an effective non-invasive tool for screening EVs in patients with hepatitis C-related chronic liver disease, demonstrating high accuracy for predicting the presence of EVs. However, its efficacy in predicting HRVs is comparable to other non-invasive indices and warrants further validation.

Abdominal Ultrasonography and Splenoportal Doppler Study for Predicting Oesophageal Varices in Patients Admitted with Chronic Liver Disease at a Tertiary Medical Hospital in Kolkata, India: A Cross-sectional Study

Introduction: Upper Gastrointestinal Endoscopy is considered the best screening tool for varices among patients with chronic liver disease. However, it is an expensive and invasive procedure that is not routinely available in rural India. Abdominal ultrasonography along with colour Doppler study is an inexpensive test commonly ordered for patients with chronic liver disease. Recent literature suggests that ultrasonographic parameters can be used to predict varices. Aim: To determine if ultrasonography of the entire abdomen and spleno-portal Doppler study findings can predict oesophageal varices in patients with chronic liver disease. Materials and Methods: The present hospital-based observational, cross-sectional study was conducted in the indoor ward of the Department of General Medicine at Medical College and Hospital, Kolkata, India, over a duration of one year from February 2021 to February 2022. Total 100 patients with chronic liver disease, admitted to the hospital ward, were included in the study. Child-Turcotte-Pugh (CTP) scores were obtained for all patients. Ultrasonographic and spleno-portal Doppler indices, such as liver size, spleen size, portal vein diameter, splenic vein diameter, peak systolic velocity of the portal vein, and portal vein/splenic vein diameter ratio, were measured alongside upper gastrointestinal endoscopy to detect varices. The data were analysed using Statistical Package for Social Sciences (SPSS) version 28.0. The Chi-square test was used to test for significant differences in proportions (categorical data), and the independent t-test and Analysis of Variance (ANOVA) with Tukey’s Post-hoc test were employed to test for significant differences in means (continuous data). Additionally, Receiver Operating Characteristic (ROC) curves were obtained for statistically significant parameters to predict the presence of varices. Results: The study enrolled 100 patients (63% males, 37% females) with a mean age of 49.19±14.965 years, ranging from 14 to 91 years. (median age of 52, range 14-91 years). Of these, 68 patients (68%) had oesophageal varices, while 32 (32%) did not. The study found that a mean spleen size of 13.55 cm, a mean portal vein diameter of 12.5 mm, and a mean splenic vein diameter of ≥9.05 mm were predictive of varices. Additionally, a mean portal vein/splenic vein diameter ratio of 1.6150 was also predictive of varices. However, there was no significant difference in mean liver size and peak systolic velocity between those with and without varices. Conclusion: The present study suggests that a spleen size, portal vein diameter, splenic vein diameter, and portal vein/splenic vein diameter ratio can be reliably used to predict oesophageal varices among patients with chronic liver disease.

Exploring new noninvasive parameters to predict oesophageal varices in patients with NAFLD-associated compensated liver cirrhosis

Exploring new noninvasive parameters to predict oesophageal varices in patients with NAFLD-associated compensated liver cirrhosis

Evaluation of Noninvasive Tools for Predicting Esophageal Varices in Patients With Cirrhosis at Tygerberg Hospital, Cape Town.

Background: In patients with cirrhosis, esophageal variceal hemorrhage (EVH) is a devastating consequence of portal hypertension (PH). Upper endoscopy is considered the gold standard for the detection and diagnosis of esophageal varices (EVs), despite being invasive and costly. This study was aimed at identifying and evaluating the diagnostic accuracy of noninvasive tools in predicting EVs in patients with compensated cirrhosis. Methods: This cross-sectional study included 50 patients with compensated cirrhosis at the Tygerberg Hospital Gastroenterology Clinic in Cape Town between November 2022 and May 2023. We collected clinical, anthropometric, and laboratory data from patients' physical and electronic charts. All patients underwent an abdominal ultrasound, vibration-controlled transient elastography (VCTE) to assess liver and splenic stiffness, and upper endoscopy. In this comparative study, we evaluated the diagnostic accuracy of different noninvasive tools in detecting EVs in patients with compensated cirrhosis. Results: Of the 50 patients included in the study, 30 (60%) were female and 20 (40%) were male. The patients' age ranged from 18 to 83, with a mean age of 46.6 years. Cirrhosis was mainly due to alcohol use (n = 11, 22%), hepatitis B virus (HBV) infection (n = 11, 22%), and autoimmune hepatitis (n = 10, 20%). The patients included in the study were divided into two subgroups: with (n = 34, 68%) or without (n = 16, 32%) EVs. Statistically significant differences were detected between groups in platelet count (PC), liver stiffness measurement (LSM), spleen stiffness measurement (SSM), portal vein diameter (PVD), bipolar spleen diameter (SBD), aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis-4 index (FIB-4), platelet/bipolar spleen diameter ratio (PSR), liver stiffness-spleen size-platelet ratio (LSPS), liver stiffness-spleen stiffness-platelet ratio score (LS3PS), and spleen stiffness-spleen size-platelet ratio score (SSPS) (p < 0.001). The highest diagnostic precision was observed with SSM (96%), SSPS (96%), LS3PS (94%), LSPS (94%), PSR (94%), and PC (92%). SBD (88%), LSM (86%), APRI (82%), and FIB-4 (82%) had the lowest diagnostic accuracy. Conclusion: SSM and SSPS have the highest diagnostic accuracy for predicting the presence of EVs in patients with compensated cirrhosis. LSPS, LS3PS, and PSR come second at 94%. We recommend SSM and SSPS in institutions with transient elastography equipped with the software necessary to measure splenic stiffness. We introduce and propose LS3PS as a novel composite score for predicting the presence of EVs in patients with compensated cirrhosis. Large-sample-size studies are needed to validate these prediction scores and to allow direct comparison with Baveno VII. These prediction tools can help clinicians avoid unnecessary endoscopic procedures in patients with compensated cirrhosis, especially in developing countries with limited resources such as South Africa.

Letter to editor ‘Non-invasive model for predicting high-risk esophageal varices based on liver and spleen stiffness’

This letter to the editor relates to the study entitled "Non-invasive model for predicting high-risk esophageal varices based on liver and spleen stiffness". Acute bleeding caused by esophageal varices is a life-threatening complication in patients with liver cirrhosis. Due to the discomfort, contraindications, and associated complications of upper gastrointestinal endoscopy screening, it is crucial to identify an imaging-based non-invasive model for predicting high-risk esophageal varices in patients with cirrhosis.

Screening of Esophageal Varices in Patients With Fontan Palliation

Screening of Esophageal Varices in Patients With Fontan Palliation

Prediction of Severe Esophageal Varices in Patients With Cirrhosis Based on Levitt's CO Breath Test: A Proof of Concept Study.

This study investigated the feasibility of using erythrocyte (RBC) lifespan determined by Levitt's CO breath test (LCOBT) to predict esophageal varices needing treatment (VNT) in patients with cirrhosis. Esophageal varix bleeding is a common fatal complication of cirrhosis and portal hypertension. The gold standard for identifying VNT is esophagogastroduodenoscopy (EGD), an invasive procedure with low patient compliance. VNT screening based on Baveno VI criteria has mediocre specificity. RBC lifespan was determined by LCOBT in 53 cirrhotic patients (13 without varices, 11 mild/moderate varices, and 29 severe varices). Correlation of varix severity with RBC lifespan and other variables was analyzed. Rates of shortened RBC lifespan and thrombocytopenia (Baveno VI criteria) were compared. RBC lifespan correlated inversely with severity of varices (r=-0.793, P<0.001). Mean RBC lifespans were 129±31, 96±21, and 59±21 days for Nonvarix, Mild/Moderate, and Severe groups. Shortened RBC lifespan (<75d) was observed in 79.3% (23/29) of patients with severe varices, a frequency similar or identical to thrombocytopenia rates [original Baveno VI criteria, 86.2% (25/29), P=0.487; expanded criteria, 79.3% (23/29), P>0.999]. Among 24 patients without severe varices, shortened RBC lifespan was observed in 1 patient whereas thrombocytopenia was detected in 13 and 8 patients based on the original (P<0.001) and expanded criteria (P=0.010), respectively. RBC lifespan correlates inversely with varix severity in patients with cirrhosis. LCOBT may enable specific screening for VNT.

Serum Kallistatin Level as a Predictor of Esophageal Varices in Patients of Liver Cirrhosis

Abstract Background Esophageal varices are porto-systemic collaterals resulting from portal hypertension, and considered the most lethal complication of liver cirrhosis so early diagnosis of varices can improve prognosis of liver cirrhosis. Kallistatin a tissue kallikrein-binding protein and a serine proteinase inhibitor (serpin) is mainly formed and secreted in liver and its serum level diminished in liver cirrhosis. It has anti-angiogenic, anti-oxidant, anti-inflammatory and anti-tumor effects. Kallistatin level is believed by many literature to be related to the severity of liver disease. Aim of the Work The aim of this study was to assess the relation between serum kallistatin level and presence of OVs. This study also aimed to evaluate serum kallistatin level as a non-invasive predictor of OVs. Patients and Methods This study was conducted in the Gastro-enterology unit, Internal medicine department, Ain Shams University hospitals &amp;Theodor Bilharz Institute. This is a case control study including 60 cirrhotic patients and 20 healthy. Results There was no significant differences between the studied groups regarding demographic data. There was no significant differences between the studied groups as regards Hb, WBCs, ALT, AST, creatinine and, urea but there was highly significant differences between cirrhotic groups and healthy group in the means of platelet count, serum albumin, serum sodium, total and direct bilirubin but no significant difference between groups I and II. Regarding to prothrombin time, there was highly significant differences between the 3 groups as it was higher in group I more than II more than III. There was also no significant difference between the cirrhotic groups regarding to Child Pugh score, MELD score and portal hypertensive gastropathy (PHG). There were significant differences between the 3 studied groups regarding to the means of splenic diameter and portal vein diameter. Kallistatin level showed significant decrease in both patients with OVs and patients without OVs vs. healthy individuals and there was highly significant difference between patients with OVs and patients without OVs. The level of Kallistatin concentration is not correlated with size of varices or risky signs suggesting that Kallistatin level can predict presence of O.V but it can’t reflect the size and severity of varices. There was no significant correlation between serum level of Kallistatin and age, gender and smoking. There was positive correlation to hemoglobin, platelet count, albumin level and negative correlation with PT, INR and urea. There was positive correlation to portal hypertensive gastropathy (PHG) and negative correlation with MELD score and portal vein diameter. Conclusion Serum level of Kallistatin level may express the degree of liver dysfunction. It is correlated with presence of O.V but not correlate to size or risky signs of OVs suggesting that Kallistatin level can’t reflect the presence of O.V. It can predict the presence of severe PHG.

Predicting the Severity of Esophageal Varices in Patients with Hepatic Cirrhosis Using Non-Invasive Markers.

The presence and extent of severity of esophageal varices (EV) in patients with liver cirrhosis (LC) are predicted using noninvasive clinical, biochemical, and imaging parameters. The aim of this study was to investigate the accuracy of noninvasive predictors of EV, such as the platelet count-to-spleen diameter ratio (PSR), platelet count-to-spleen volume ratio (PSVR), spleen size (SZ), and a combination of these markers in determining the severity of EV in patients with cirrhosis. We recruited 82 inpatients with LC from the Department of Gastroenterology at the First Affiliated Hospital of Guangxi Medical University between January 2018 and December 2019 for this diagnostic investigation. All patients underwent endoscopy, ultrasound, computed tomography, and routine laboratory investigations. For the study, we evaluated and compared the diagnostic accuracy of PSR, PSVR, SZ, and their combinations. There were significant differences in the area under the receiver operating characteristic (ROC) curve (AUC) in the prediction of severe and moderate/severe EV for all the variables. PSR+PSVR had the highest AUC at 0.735 (95% CI: 0.626-0.826) and 0.765 (95% CI: 0.659-0.852) for predicting severe and moderate/severe EV, respectively. There were statistically significant differences in the AUCs (95% CI) for PSR, PSVR, and PSR+PSVR in predicting the existence of EV. As per the overall model quality chart, the combination of PSR+PSVR was the best indicator for detecting the presence of EV (AUC, 0.696; 95% CI: 0.584-0.792). In our study, we found that these noninvasive parameters could predict the extent of severity of EV in patients with LC. We anticipate the use of a combination of PSR + PSVR to emerge as the superior indicator as studies progress.