Risk Of Varices Research Articles

Assessment of four-dimensional flow MRI for prediction of varices risk in cirrhotic patients.

This study aims to validate the application of abdominal four-dimensional flow magnetic resonance imaging (MRI) for cirrhotic patients and quantify its effectiveness in assessing the hemodynamic impacts of cirrhosis to evaluate varices. All consecutive patients who underwent MRIs between September 2022 and June 2023 were enrolled. Groups were divided into varicose, non-varicose, and healthy groups. ANOVA and post hoc LSD-t tests were used for statistical analysis. The correlation between hemodynamic parameters and liver function grade was evaluated using Kendall's correlation coefficient. A total of 80 patients were included (53 cirrhotic, 27 healthy). Significant disparities were found in main portal vein flow (MPV-FR), splenic vein flow (SV-FR), and vessel diameters (MPV-VD, SV-VD) among the groups (p < 0.05). MPV-FR was higher in the varicose group (24.81 ± 8.52) compared to non-varicose (19.52 ± 5.07) and healthy groups (17.26 ± 5.48). The most robust assessment of variceal risk was achieved by combining the flow rates (FRs) and VDs of MPV and SV (AUC 0.83, 95% CI 0.72-0.94). The combined indices of FRs and VDs of MPV and SV effectively predict the occurrence of varicose veins in cirrhotic patients. Question Non-invasive prediction of variceal risk is essential for the clinical management of advanced chronic cirrhosis, yet existing clinical examinations are inadequate. Findings The effective assessment of variceal risk was achieved by combining the flow rates and vessel diameters of the main portal vein and splenic vein. Clinical relevance Four-dimensional flow MRI can reveal hemodynamic changes in cirrhotic patients and assist in identifying gastroesophageal varices, serving as a marker for varices risk prediction.

Development and Validation of a Noninvasive Model for the Detection of High-Risk Varices in Patients with Unresectable HCC

Background and AimsNon-invasive variceal risk stratification systems have not been validated in patients with hepatocellular carcinoma (HCC), which presents logistical barriers for patients in the setting of systemic HCC therapy. We aimed to develop and validate a non-invasive algorithm for the prediction of varices in patients with unresectable HCC. MethodsWe performed a retrospective cohort study in 21 centers in the US including adult patients with unresectable HCC and Child Pugh A5-B7 cirrhosis diagnosed between 2007 and2019. We included patients who completed an esophagogastroduodonoscopy (EGD) within 12 months of index imaging but prior to HCC treatment. We divided the cohort into a 70:30 training set and validation set, with the goal of maximizing negative predictive value (NPV) to avoid EGD in low-risk patients. ResultsWe included 707 patients (median age 64.6 years, 80.6% male and 74.0% White). Median time from HCC diagnosis to EGD was 47 (IQR: 114) days, with 25.0% of patients having high-risk varices. A model using clinical variables alone achieved a NPV of 86.3% in the validation cohort, while a model integrating clinical and imaging variables had an NPV 97.4% in validation. The clinical and imaging model would avoid EGDs in over half of low-risk patients while misclassifying 7.7% of high-risk patients. ConclusionA model incorporating clinical and imaging data can accurately predict the absence of high-risk varices in patients with HCC and avoid EGD in many low-risk patients prior to the initiation of systemic therapy, thus expediting their care and avoiding treatment delays.

Non-invasive model for predicting high-risk esophageal varices based on liver and spleen stiffness.

Acute bleeding due to esophageal varices (EVs) is a life-threatening complication in patients with cirrhosis. The diagnosis of EVs is mainly through upper gastrointestinal endoscopy, but the discomfort, contraindications and complications of gastrointestinal endoscopic screening reduce patient compliance. According to the bleeding risk of EVs, the Baveno VI consensus divides varices into high bleeding risk EVs (HEVs) and low bleeding risk EVs (LEVs). We sought to identify a non-invasive prediction model based on spleen stiffness measurement (SSM) and liver stiffness measurement (LSM) as an alternative to EVs screening. To develop a safe, simple and non-invasive model to predict HEVs in patients with viral cirrhosis and identify patients who can be exempted from upper gastrointestinal endoscopy. Data from 200 patients with viral cirrhosis were included in this study, with 140 patients as the modelling group and 60 patients as the external validation group, and the EVs types of patients were determined by upper gastrointestinal endoscopy and the Baveno VI consensus. Those patients were divided into the HEVs group (66 patients) and the LEVs group (74 patients). The effect of each parameter on HEVs was analyzed by univariate and multivariate analyses, and a non-invasive prediction model was established. Finally, the discrimination ability, calibration ability and clinical efficacy of the new model were verified in the modelling group and the external validation group. Univariate and multivariate analyses showed that SSM and LSM were associated with the occurrence of HEVs in patients with viral cirrhosis. On this basis, logistic regression analysis was used to construct a prediction model: Ln [P/(1-P)] = -8.184 -0.228 × SSM + 0.642 × LSM. The area under the curve of the new model was 0.965. When the cut-off value was 0.27, the sensitivity, specificity, positive predictive value and negative predictive value of the model for predicting HEVs were 100.00%, 82.43%, 83.52%, and 100%, respectively. Compared with the four prediction models of liver stiffness-spleen diameter to platelet ratio score, variceal risk index, aspartate aminotransferase to alanine aminotransferase ratio, and Baveno VI, the established model can better predict HEVs in patients with viral cirrhosis. Based on the SSM and LSM measured by transient elastography, we established a non-invasive prediction model for HEVs. The new model is reliable in predicting HEVs and can be used as an alternative to routine upper gastrointestinal endoscopy screening, which is helpful for clinical decision making.

Noninvasive risk assessment of hepatic decompensation in patients with hepatitis B virus-related liver cirrhosis.

Hepatic decompensation is a major complication of liver cirrhosis. We validated the predictive performance of the newly proposed CHESS-ALARM model to predict hepatic decompensation in patients with hepatitis B virus (HBV)-related cirrhosis and compared it with other transient elastography (TE)-based models such as liver stiffness-spleen size-to-platelet (LSPS), portal hypertension (PH), varices risk scores, albumin-bilirubin (ALBI), and albumin-bilirubin-fibrosis-4 (ALBI-FIB-4). Four hundred eighty-two patients with HBV-related liver cirrhosis between 2006 and 2014 were recruited. Liver cirrhosis was clinically or morphologically defined. The predictive performance of the models was assessed using a time-dependent area under the curve (tAUC). During the study period, 48 patients (10.0%) developed hepatic decompensation (median 93months). The 1-year predictive performance of the LSPS model (tAUC=0.8405) was higher than those of the PH model (tAUC=0.8255), ALBI-FIB-4 (tAUC=0.8168), ALBI (tAUC=0.8153), CHESS-ALARM (tAUC=0.8090), and variceal risk score (tAUC=0.7990). The 3-year predictive performance of the LSPS model (tAUC=0.8673) was higher than those of the PH risk score (tAUC=0.8670), CHESS-ALARM (tAUC=0.8329), variceal risk score (tAUC=0.8290), ALBI-FIB-4 (tAUC=0.7730), and ALBI (tAUC=0.7451). The 5-year predictive performance of the PH risk score (tAUC=0.8521) was higher than those of the LSPS (tAUC=0.8465), varices risk score (tAUC=0.8261), CHESS-ALARM (tAUC=0.7971), ALBI-FIB-4 (tAUC=0.7743), and ALBI (tAUC=0.7541). However, there was no significant difference in the predictive performance among all models at 1, 3, and 5years (P>0.05). The CHESS-ALARM score was able to reliably predict hepatic decompensation in patients with HBV-related liver cirrhosis and showed similar performance to the LSPS, PH, varices risk scores, ALBI, and ALBI-FIB-4.

Correlation of Child-Pugh Classification with Esophageal Varices in Patients with Liver Cirrhosis

Introduction: The severity of the chronic liver disease can be assessed by several non-invasive methods one of them includes scoring system like Child-Pugh classification.&#x0D; Aims: The objective of this study was to assess the correlation of Child Pugh class with esophageal varices in patients with liver cirrhosis.&#x0D; Methods: This was a cross-sectional hospital-based study of 406 patients with liver cirrhosis. Demographic and relevant clinical data were collected using a standardized questionnaire. Abdominal ultrasound, liver function test, full blood count, viral markers were done for all patients. All patients underwent upper gastrointestinal endoscopy to screen for varices and if found were categorized as small and large.&#x0D; Results: A total of 406 patients with a mean age of 48 ± 11 years were evaluated. There were 72.4% and 27.6% men and women respectively. Variceal screening by upper gastrointestinal endoscopy revealed esophageal varices in 90.1% patients. By Child-Pugh Classification, 60 (14.8%) patients were in class A, 156 (38.4%) in class B and 190 (46.8%) in class C. Among patients with Child class A, 29 (48.3%) had varices. Similarly, 147 (94.2%) and 190 (100%) of Child class B &amp; C had varices respectively. Odds of presence of esophageal varix were 9 times higher for patients with Child-Pugh Classification B and C compared to class A.&#x0D; Conclusion: Most patients with cirrhosis present late and with advanced stage in this referral center. Most have esophageal varices on their first screening endoscopy. Child-Pugh classification is a reliable measure of stratifying variceal risk in chronic liver disease patients.

FRI535 - A multi-compartmental model of the HepQuant SHUNT test can quantify anatomic shunting and stratify risk for varices: combined results from the HALT-C and SHUNT-V studies

FRI535 - A multi-compartmental model of the HepQuant SHUNT test can quantify anatomic shunting and stratify risk for varices: combined results from the HALT-C and SHUNT-V studies

Validation of Baveno VI and Expanded-Baveno VI Criteria for predicting gastroesophageal varices in patients with alcoholic and non-alcoholic fatty liver disease.

Baveno VI and Expanded-Baveno VI Criteria were validated to rule out high-risk esophageal varices (HRV) and to prevent unneeded endoscopies in compensated advanced chronic liver disease (cACLD) mainly related to viral hepatitis. We aim to assess these criteria to rule out low- and high- risk varices in patients with cACLD secondary to alcoholic liver disease (ALD) and non- alcoholic fatty liver disease (NAFLD). Data were collected retrospectively from 2016 to 2020. Inclusion criteria were: NAFLD and /or ALD related cACLD, a liver stiffness measurement (LSM) ≥ 10 kPa and an esophagogastroduodenoscopy (EGD) within 12 months. Exclusion criteria were: use of non cardioselective β-blockers, hepatic decompensation, previous variceal bleeding, portal thrombosis, liver cancer, or liver transplant. One hundred and ninety-four patients were included in this study. Eighty-one patients (42%) met Baveno VI criteria and 103 (53%) met Expanded-Baveno VI criteria. Baveno VI criteria yielded a high negative predictive value (NPV ≥ 95%) for detecting HRV and varices of any size. Expanded-Baveno VI criteria yielded a high NPV ≥ 95% only for detecting HRV: the miss rate for varices of any size was 8%. Expanded-Baveno VI criteria could avoid more endoscopies than the original Baveno VI criteria to rule out HRV (53% versus 42%). In this study, both criteria showed high NPV to rule out HRV but only original Baveno VI criteria yielded a satisfactory high NPV to rule out varices of any size. Expanded-Baveno VI criteria could avoid more endoscopies to exclude HRV.

Validation of PH and Varices Risk Scores for Prediction of High-Risk Esophageal Varix and Bleeding in Patients with B-Viral Cirrhosis.

Esophageal varices (EVs) can be accurately predicted using PH and varices risk scores. We aimed to validate their prognostic performances. Methods: We enrolled patients with B-viral cirrhosis as the training cohort (n = 503). Areas under receiver operating characteristic curves (AUROCs) for HEV were calculated for PH (=−5.953 + 0.188 × liver stiffness (LS) + 1.583 × sex (1:male/0:female) + 26.705 × spleen diameter/platelet count ratio) and varices (=−4.364 + 0.538 × spleen diameter −0.049 × platelet count −0.044 × LS + 0.001 × LS × platelet count) risk scores, and compared to LSPS (=LS × spleen diameter/platelet count). An independent cohort was recruited for further validation (n = 222). In the training cohort, the varices risk score showed the highest AUROC (0.926), followed by the PH risk score (0.924) and LSPS (0.924), but without any statistically significant differences. For varices risk scores ≤−1.70 and ≥1.48, a 95.0% negative predictive value (NPV) and 91.2% positive predictive value (PPV) were observed, respectively. At PH risk scores ≤2.25 and ≥7.71, 95.0% NPV and 90.0% PPV were observed, respectively. At LSPS ≤1.73 and ≥13.9, 95.3% NPV and 95.0% PPV were observed, respectively. The EV bleeding (EVB) risk during follow-up increased stepwise and significantly when stratified by PH, varices risk scores, and LSPS (all p < 0.001). In the validation cohort, NPVs were generally similar when stratified by PH (88.2%), varices risk scores (93.2%), and LSPS (88.9%); however, corresponding PPVs were suboptimal. PH and variceal risk scores are reliable for predicting HEV and future EVB. Patients with PH and varices risk scores ≤2.25 and ≤−1.70, respectively, may avoid endoscopy safely. For convenience, LSPS might be a good alternative, with comparable prognostic performance to these two models.

Diagnostic Accuracy of Multi-Detector Computed Tomography Esophagography in Grading of Esophageal Varices in Cirrhotic Patients

Objective: To assess the diagnostic accuracy of computed tomography esophagography in grading esophageal varices using upper gastrointestinal endoscopy as a gold standard. Study Design: Cross-sectional (validation) study Place and Duration of Study: Radiology department, Holy Family Hospital, Rawalpindi from 14th July 2016 to 13th January 2017. Methodology: One hundred and forty five clinically diagnosed patients of liver cirrhosis, age between 35-80 years were enrolled in this study. All patients underwent multi-detector computed tomography and endoscopy examination for the identification as well as grading of oesophageal varices. Results: High risk varices were identified in 106 (73.1%) of patients on multi-detector computed tomography and were identified in 108 (74.5%) of patients on endoscopy. Sensitivity, specificity, negative predictive value, positive predictive value and accuracy of multi-detector computed tomography forthe identification of high risk esophageal varices were found to be 94.4%, 89.2%, 84.6%, 96.2% and 93.1% respectively. Conclusion: Multi-detector computed tomography esophagography detected high risk esophageal varices with excellent accuracy. This could be a practical and non-invasive choice of imaging for the identification&amp; grading of esophageal varices. Key words: Esophageal varices, Multi-detector computed tomography (MDCT), Endoscopy

The role of liver and spleen elastography in advanced chronic liver disease.

Portal hypertension is the main driver of complications in patients with advanced chronic liver disease (ACLD). In the last decade, many non-invasive tests, such us liver and spleen elastography, have been proposed and validated for the identification of patients with clinically significant portal hypertension (CSPH) and its complications, mainly hepatic decompensation and liver-related morbidity and mortality. Moreover, elastography accurately stratifies for the risk of HCC development, HCC recurrence and decompensation after liver surgery. Recent studies suggest a role of SSM in monitoring response to treatments and interventions in ACLD, such as viral eradication, non-selective beta-blockers and transjugular intrahepatic portosystemic shunt placement. However, one of the most indications to perform elastography in ACLD still remains the screening for esophageal varices. In fact, according to the Baveno VI consensus, liver stiffness measurement (LSM) <20 kPa and platelet count >150,000/mm3 can safely identify patients at low risk of varices requiring treatment (VNT) and could therefore avoid invasive upper invasive endoscopy; LSM>20-25 kPa can accurately rule-in CSPH in patients with viral etiology. Spleen stiffness measurement (SSM) is a direct surrogate of portal hypertension and has been demonstrated more accurate in predicting portal hypertension severity and VNT. A combined model including Baveno VI Criteria and SSM (≤46 kPa) can significantly increase the number of spared endoscopies (>40-50%), maintaining a low (<5%) of missed VNT.

Diagnostic accuracy of liver and spleen stiffness measured by fibroscan® in the prediction of esophageal varices in HCV-related cirrhosis patients treated with oral antivirals

IntroductionThe aim of this study was to investigate the accuracy of liver and spleen stiffness measurement by transient elastography for the prediction of gastroesophageal varices in patients with HCV-associated cirrhosis treated with new direct-acting antiviral agents. Patients and methodsThis cross-sectional observational study included patients with compensated HCV-related cirrhosis and sustained virological response after direct-acting antiviral therapy. Patients underwent liver and spleen stiffness measurement, abdominal ultrasound and oesophago-gastroduodenoscopy. Clinical and laboratory data and non-invasive markers such as the liver stiffness–spleen diameter to platelet ratio score, variceal risk index and platelet count to spleen diameter ratio were analyzed. ResultsNinety-seven consecutive patients were included. Liver stiffness measurement (12.2 vs 16; p=0.02), spleen stiffness measurement (39.4 vs 46.05; p=0.04), liver stiffness–spleen diameter to platelet ratio score (1.21 vs 2.02; p=0.008), platelet count to spleen diameter ratio (1102.19 vs 829.7; p=0.04) and variceal risk index (−3.4 vs −1.02; p=0.01) showed significant differences between patients without/with gastroesophageal varices. The best cut-off value to discard the presence of gastroesophageal varices was 12.3kPa for liver stiffness measurement and 27kPa for spleen stiffness measurement. However, diagnostic accuracy was moderate (AUROC: 0.671 and 0.624 respectively). Combining different non-invasive parameters did not significantly improve the overall performance. DiscussionLiver and spleen stiffness measurement showed suboptimal results for non-invasive assessment of gastroesophageal varices in HCV cirrhotic patients treated with direct-acting antiviral agents. Our results suggest that non-invasive methods cannot substitute standard procedures for predicting gastroesophageal varices in this population.

The Role of Aspartate Aminotransferase to Platelet Ratio Index as a Non-Invasive Predictor of Variceal Etiology of Upper Gastrointestinal Bleeding

Introduction: Non-invasive strategies to predict variceal from non-variceal bleeding will be highly beneficialfor preemptive management of Upper Gastrointestinal Bleeding (UGIB). This study aimed to assess the roleof aspartate aminotransferase (AST) to platelet ratio index (APRI) as a non-invasive predictor of varicealetiology of UGIB. Methods: This was a retrospective descriptive study conducted at Endoscopy Departmentof Dhulikhel Hospital between January 2017 and December 2019 in patients presenting with acute UGIB.We assessed the diagnostic utility of the APRI score relative to other objective measures by Area Under theReceiver Operating Characteristic (AUROC) curve analysis. Results: A total of 158 patients with historyof UGIB were included in the study. There were total 123 males (77.8%) and the mean age of the patientswas 50.3±16.1 years. The APRI score performed well in predicting a variceal etiology of acute UGIB, withAUROC 0.9. When APRI was used at cut-off of 1.3, it had a sensitivity of 84.1% and specificity of 76.8%,a positive predictive value of 70.7% and a negative predictive value of 89.9% while predicting varicealetiology of UGIB at presentation. The relative risk of varices at an APRI cut-off of 1.3 is 17.5 with a p-valueof &lt;0.0001. Conclusion: The present study highlighted that APRI score can be used as an objective metricthat helps to predict a variceal etiology of acute UGIB.

Spleen stiffness and liver stiffness for predicting high risk varices in patients with compensated liver cirrhosis

Spleen stiffness and liver stiffness for predicting high risk varices in patients with compensated liver cirrhosis

Study of glycated albumin to glycated hemoglobin ratio as a predictor of esophageal varices bleeding risk

Objectives To evaluate glycated albumin (GA) to glycated hemoglobin (HbA1c) ratio as a predictor of variceal bleeding in patients with liver cirrhosis. Background Variceal hemorrhage is a severe complication of liver cirrhosis and can be a direct cause of bleeding-related death. Therefore, upper endoscopy is considered necessary for all cirrhotic patients to evaluate the risk of variceal bleeding. Patients and methods A prospective clinical study was conducted on 100 patients with chronic hepatitis C-related cirrhosis who attended the Gastrointestinal Endoscopy Unit of the Department of Internal Medicine, Menoufia University hospitals, during the period between January 2017 and March 2018. Liver cirrhosis was diagnosed depending upon clinical examination in addition to laboratory and imaging studies. Various indicators for hepatic functions, HbA1c, and GA were measured. GA/HbA1c ratio was measured, and its relationship with the presence and bleeding risk of esophageal varices was analyzed. Results The GA/HbA1c ratio in hepatitis C virus (HCV)-positive cirrhotic patients increases with the severity of the esophageal varices. GA/HbA1c ratio may help in discrimination of low-risk from high-risk varices because GA/HbA1c ratio was the most significantly different among all of the other parameters tested; however, this is still doubtful. Conclusion Thrombocytopenia and prolonged prothrombin time parameters are associated with an increased risk of variceal bleeding. GA/HbA1c ratio in HCV-positive cirrhotic patients increases with the severity of the esophageal varices. GA/HbA1c ratio may help in discrimination of low-risk from high-risk varices. It is of interest and is not redundant to use the GA/HbA1c ratio to predict esophageal variceal bleeding risk in chronic HCV disease.

Role of non-invasive markers in prediction of esophageal varices and variceal bleeding in patients of alcoholic liver cirrhosis from central India.

Alcohol is the leading cause of liver cirrhosis, which results in portal hypertension and subsequently, culminates into esophageal varices and esophgeal variceal bleeding. Esophagogastroduodenoscopy is gold standard for diagnosis of varices. Non-invasive markers based on clinical, laboratory - ultrasonographic parameters can be utilised for prediction of risk of esophageal varices - variceal bleed in alcoholic cirrhosis from central India. This was a cross sectional observational study. Child Turcot Pugh scores, MELD, AST ALT Ratio(AAR), AST Platelet Ratio Index(APRI), FIB-4 index and Platelet count-Spleen diameter(PC/SD) ratio were calculated for all patients and correlated with esophagogastroduodenoscopy findings. Short term follow up was done for variceal bleeding. Total 202 male patients were included with mean age of 43.77±9.95 years. 188(93%) patients had esophageal varices. 61(30.19%) patients had variceal bleeding. On univariate analysis platelet count, APRI, spleen bipolar diameter, and PC/SD ratio were significantly associated with varices. For prediction of esophageal varices, only PC/SD ratio was significant and showed area under the curve of 65.6% at cut-off of <997. CTP score, FIB-4, APRI, and PC/SD ratio were significant for variceal bleeding. At cut-off <985 PC/SD ratio had sensitivity of 82% and specificity of 63% with AUC of 78% for prediction of variceal bleeding. Also, FIB-4 and APRI had diagnostic accuracy of 64% and 61% with AUC of 74% and 72% respectively for bleed. FIB-4 and PC/SD may be useful among armamentarium of non-invasive markers for predicting esophageal varices and risk of variceal bleeding in alcoholic liver cirrhosis.

SAT-414-Baveno VI principle for non-invasive assessment of high risk varices is also applicable with shear wave elastography

SAT-414-Baveno VI principle for non-invasive assessment of high risk varices is also applicable with shear wave elastography

THU-075-2d-shear wave elastography for the spleen stiffness evaluation: A non-invasive marker for predicting high risk varices in patients with compensated liver cirrhosis

THU-075-2d-shear wave elastography for the spleen stiffness evaluation: A non-invasive marker for predicting high risk varices in patients with compensated liver cirrhosis

2D-Shear Wave Elastography of the spleen - A noninvasive marker for predicting high risk varices in patients with compensated liver cirrhosis

2D-Shear Wave Elastography of the spleen - A noninvasive marker for predicting high risk varices in patients with compensated liver cirrhosis

Evaluation of Glycated Albumin to Glycated Hemoglobin Ratio as a Predictor for Esophageal varices and its Risk of Bleeding

Background: Variceal hemorrhaging due to portal hypertension is a severe complication of liver cirrhosis. Although several biomarkers have been reported as predictors of the presence of varices, it is still difficult to assess the risk of variceal bleeding without esophagogastroduodenoscopy (EGD). The ratio of glycated albumin (GA) to glycated hemoglobin (HbA1c) was reported to increase with the progression of liver fibrosis. The aim of the study was to investigate whether the GA/HbA1c ratio is related to the severity and bleeding risk of the varices. Aim of the work: goal of our study was to assess the value of Glycated albumin to Glycated hemoglobin ratio in the prediction of esophageal varices and assessing its risk of bleeding. Methods: We measured the GA/HbA1c ratio of HCV-related cirrhotic patients and analyzed its relationship with the presence and bleeding risk of varices. Results: The GA/HbA1c ratio was higher in the patients who had the varices with a high risk of hemorrhage than in the patients with a low risk of bleeding. In addition, the GA/HbA1c ratio was higher in patients with varices than that in patients without varices. Furthermore, the GA/HbA1c ratio was the most significantly different parameter of all the factors examined, including the platelet count, prothrombin activity and albumin level. Conclusion: The GA/HbA1c ratio is increased in patients with varices and with the bleeding risk of the varices.

Evaluation of Glycated Albumin to Glycated Hemoglobin Ratio as a Predictor for Esophageal varices and its Risk of Bleeding

Background: Variceal hemorrhaging due to portal hypertension is a severe complication of liver cirrhosis. Although several biomarkers have been reported as predictors of the presence of varices, it is still difficult to assess the risk of variceal bleeding without esophagogastroduodenoscopy (EGD). The ratio of glycated albumin (GA) to glycated hemoglobin (HbA1c) was reported to increase with the progression of liver fibrosis. The aim of the study was to investigate whether the GA/HbA1c ratio is related to the severity and bleeding risk of the varices. Aim of the work: goal of our study was to assess the value of Glycated albumin to Glycated hemoglobin ratio in the prediction of esophageal varices and assessing its risk of bleeding. Methods: We measured the GA/HbA1c ratio of HCV-related cirrhotic patients and analyzed its relationship with the presence and bleeding risk of varices. Results: The GA/HbA1c ratio was higher in the patients who had the varices with a high risk of hemorrhage than in the patients with a low risk of bleeding. In addition, the GA/HbA1c ratio was higher in patients with varices than that in patients without varices. Furthermore, the GA/HbA1c ratio was the most significantly different parameter of all the factors examined, including the platelet count, prothrombin activity and albumin level. Conclusion: The GA/HbA1c ratio is increased in patients with varices and with the bleeding risk of the varices.