“A study of Non-Endoscopic Predictors of Variceal Bleeding in Patients with Liver Cirrhosis”

Abstract

Background: Esophageal varices, which are caused by portal hypertension in patients with chronic liver disease, affect approximately 50% of patients with cirrhosis of the liver. Present study aimed to identify non-invasive parameters for prediction of esophageal varices in newly diagnosed patients with cirrhosis, without previous upper gastro intestinal bleed. Material & Method: The present prospective observational study was conducted among the patients attending to medical wards and acute medical care unit, department of medicine, SVRRGGH, Tirupati. From June 2021 to May 2022 with suggestive of liver cirrhosis. Patients with liver cirrhosis with portal hypertension between 18-80yrs of age were included. The study was conducted after obtaining the clearance from ethics committee, and written consent from participants. At the time of admission, all patients underwent a thorough clinical evaluation. Relevant history, etiology of liver disease, and physical characteristics such as age, gender, symptoms and signs of liver failure, hepatomegaly, splenomegaly, and abdominal vein collaterals were all recorded. Endoscopy and ultrasound investigation were performed along with the blood parameter profile. The collected data were analysed using SPSS v23.0 with significance of 0.05.
Result: A fifty patients with mean age of 47.1yrs were included. Among them 14 were female and 36 were male patients (male preponderance). Etiology of liver disease in the study was alcohol for 24 patients, followed by HBV for 2, autoimmune hepatitis for 2, HCV for 1 patient. Severity of liver disease calculated by CTP is as follows, Class A: 6, Class B: 16, Class C: 27, five had suffered with Encephalopathy, 20 had splenomegaly. There was significant association of grade of varices with platelet count, prothrombin time, low albumin level, presence of encephalopathy and presence of portal hypertension. Also the child-pugh score had a linear relation with grade of varices

Conclusion: It is concluded that non-endoscopic factors like splenomegaly, decreased platelet count, hypoalbuminemia, mean portal vein diameter and mean splenic diameter, Child-Pugh score or a combination of multiple indices, as well as ultrasonographic (US) elastography proved to be the more accurate non-endoscopic predictors of esophageal varices and can also differentiate between the variceal size.