The velocity of volume increase of esophageal varices has a predictive value of the bleeding risk in cirrhotic patients

Background and Study Aims: Portal hypertension is one of the most important complications of liver cirrhosis. The prevalence of varices among cirrhotic patients is variable. Therefore, endoscopic screening of all patients with liver cirrhosis would result in a large number of unnecessary additional burdens to endoscopic units. Our aim was to assess the diagnostic accuracy of spleen stiffness measured by transient elastography (Fibroscan) for prediction of the presence of varices in patients with hepatitis C related cirrhosis. Patients and Methods: The study was carried out on 100 patients with HCV-induced cirrhosis and were divided into 2 groups according to presence or absence of varices by Esophago-gastro-duodenoscopy: Group I: patients with HCV-induced cirrhosis with varices; Group II: patients with HCV-induced cirrhosis without varices. Clinical and laboratory parameters, andominal ultrasonography, Upper gastrointestinal endoscopy and transient elastography to assess the liver and spleen stiffness were carried out to all studied persons. Results: Spleen stiffness had significant diagnostic value to differentiate between cirrhotic patients with varices and cirrhotic patients without varices , it had significant diagnostic value in presence of esophageal varices at cut-off (≥46.4 K Pascal) the sensitivity for detection of esophageal varices was 93%, specificity 100%, positive predictive value (PPV) was 80%, negative predictive value (NPV) was 100%; accuracy was 95% and area under the curve was 0.98 denoting that spleen stiffness is a good predictor of esophageal varices. Conclusion: Spleen stiffness was considered as an excellent predictor of esophageal varices and better than liver stiffness in prediction of esophageal varices presence and had significant diagnostic value to differentiate between the patients with varices and patients without varices at cut off (≥46.4 K Pascal) and it may have a role in variceal grading.

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A New Sampling Method for Spleen Stiffness Measurement Based on Quantitative Acoustic Radiation Force Impulse Elastography for Noninvasive Assessment of Esophageal Varices in Newly Diagnosed HCV-Related Cirrhosis

BioMed Research International ◽

10.1155/2014/365982 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 16

Author(s):

Leonardo Rizzo ◽

Massimo Attanasio ◽

Marilia Rita Pinzone ◽

Massimiliano Berretta ◽

Michele Malaguarnera ◽

...

Keyword(s):

Likelihood Ratio ◽

Esophageal Varices ◽

Predictive Value ◽

Sampling Method ◽

Acoustic Radiation ◽

Positive Likelihood Ratio ◽

Radiation Force ◽

Acoustic Radiation Force ◽

Acoustic Radiation Force Impulse ◽

Cirrhotic Patients

In our study, we evaluated the feasibility of a new sampling method for splenic stiffness (SS) measurement by Quantitative Acoustic Radiation Force Impulse Elastography (Virtual Touch Tissue Quantification (VTTQ)).We measured SS in 54 patients with HCV-related cirrhosis of whom 28 with esophageal varices (EV), 27 with Chronic Hepatitis C (CHC) F1–F3, and 63 healthy controls. VTTQ-SS was significantly higher among cirrhotic patients with EV (3.37 m/s) in comparison with controls (2.19 m/s,P<0.001), CHC patients (2.37 m/s,P<0.001), and cirrhotic patients without EV (2.7 m/s,P<0.001). Moreover, VTTQ-SS was significantly higher among cirrhotic patients without EV in comparison with both controls (P<0.001) and CHC patients (P<0.01). The optimal VTTQ-SS cut-off value for predicting EV was 3.1 m/s (AUROC = 0.96, sensitivity 96.4%, specificity 88.5%, positive predictive value 90%, negative predictive value 96%, positive likelihood ratio 8.36, and negative likelihood ratio 0.04). In conclusion, VTTQ-SS is a promising noninvasive and reliable diagnostic tool to screen cirrhotic patients for EV and reduce the need for upper gastrointestinal endoscopy. By using our cut-off value of 3.1 m/s, we would avoid endoscopy in around 45% of cirrhotic subjects, with significant time and cost savings.

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A Novel Machine Learning-Based Radiomic Model for Diagnosing High Bleeding Risk Esophageal Varices in Cirrhotic Patients

10.21203/rs.3.rs-889812/v1 ◽

2021 ◽

Author(s):

Yijie Yan ◽

Yue Li ◽

Chunlei Fan ◽

Yuening Zhang ◽

Shibin Zhang ◽

...

Keyword(s):

Machine Learning ◽

Sensitivity And Specificity ◽

Esophageal Varices ◽

External Validation ◽

Bleeding Risk ◽

Internal Validation ◽

Portal Venous Phase ◽

Net Reclassification Improvement ◽

Cirrhotic Patients ◽

High Bleeding Risk

Abstract Background & aims: To develop and validate a novel machine learning-based radiomic model (RM) for diagnosing high bleeding risk esophageal varices (HREV) in cirrhosis. Methods: In training cohort, total 218 cirrhotic patients for mild esophageal varices (EV) and 240 for HREV RM were enrolled for training and internal validation. In external validation cohort, 159 and 340 cirrhotic patients were respectively used for mild EV and HREV RM validation. Interesting regions of liver, spleen, and esophagus were labeled on the portal venous-phase enhanced CT images. RM was assessed by area under the receiver operating characteristic curves (AUROC), sensitivity, specificity, calibration and decision curve analysis (DCA). Results: The AUROC of mild EV RM in training and internal validation was 0.943 and 0.732, sensitivity and specificity was 0.863, 0.773 and 0.763, 0.763. The AUROC, sensitivity and specificity was 0.654, 0.773 and 0.632 in external validation. Interestingly, the AUROC of HREV RM in training and internal validation was 0.983 and 0.834, sensitivity and specificity was 0.948, 0.916 and 0.977, 0.969. The AUROC, sensitivity and specificity was 0.736, 0.690 and 0.762 in external validation. Calibration and DCA indicated RM had good performance in clinical practice. Compared with Baveno VI and its expanded criteria, HREV RM had a higher accuracy and net reclassification improvement reached 49.0% and 32.8%. Conclusion: A novel non-invasive RM for diagnosing HREV in cirrhotic patients with highly accuracy was developed. However, this RM still needs to be validated by a multi-center large cohort.

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The Presence of Ascites Affects the Predictive Value of HVPG on Early Rebleeding in Patients with Cirrhosis

Gastroenterology Research and Practice ◽

10.1155/2020/1329857 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Chuan Liu ◽

Ruoyang Shao ◽

Sining Wang ◽

Guangchuan Wang ◽

Lifen Wang ◽

...

Keyword(s):

Retrospective Study ◽

Variceal Bleeding ◽

Predictive Value ◽

Characteristic Curve ◽

Venous Pressure ◽

Predictive Performance ◽

Bleeding Risk ◽

Endoscopic Variceal Ligation ◽

Acute Variceal Bleeding ◽

Cirrhotic Patients

Background and Aims. Gastroesophageal variceal bleeding is a serious complication of portal hypertension in cirrhotic patients and could be predicted by hepatic venous pressure gradient (HVPG). However, whether the presence of ascites affects the prognostic value of HVPG for patients with acute variceal bleeding is still unknown. This retrospective study is aimed at investigating the influence of ascites on predictive performance of HVPG for early rebleeding in cirrhotic patients with acute variceal bleeding. Methods. In this retrospective study, a total of 148 patients with cirrhosis hospitalized for acute variceal bleeding who underwent HVPG measurement and endoscopic variceal ligation (EVL) for the prevention of rebleeding were included. The receiver operating characteristic curve (ROC) and logistical regression method were employed to analyze the predictive performance of HVPG for early rebleeding. The locally weighted scatterplot smoothing approach was adopted to assess the monotonicity between bleeding risk and HVPG. Results. A significantly higher HVPG level was observed in patients with early rebleeding compared to patients without rebleeding in the nonascites cohort. When using HVPG to predict early rebleeding, there was a lower area under curve in the ascites cohort compared to the nonascites cohort. HVPG was recognized as a risk factor for early rebleeding by a logistic regression model only in the nonascites cohort. An overall monotonicity in the trend of change in HVPG and risk for early rebleeding was observed in the nonascites cohort solely. Conclusion. The predictive value of HVPG for early rebleeding in patients with cirrhosis that developed acute variceal bleeding is hindered by the presence of ascites.

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Mac-2 Binding Protein Glycosylation Isomer for Screening High-Risk Esophageal Varices in Liver Cirrhotic Patient

Livers ◽

10.3390/livers1020006 ◽

2021 ◽

Vol 1 (2) ◽

pp. 60-67

Author(s):

Saut Horas H. Nababan ◽

Kemal Fariz Kalista ◽

Chyntia O.M. Jasirwan ◽

Juferdy Kurniawan ◽

Cosmas Rinaldi A. Lesmana ◽

...

Keyword(s):

High Risk ◽

Esophageal Varices ◽

Predictive Value ◽

Transient Elastography ◽

Binding Protein ◽

Surrogate Marker ◽

Protein Glycosylation ◽

Vein Thrombosis ◽

Non Invasive ◽

Cirrhotic Patients

Background: Esophageal varices occur at middle to advanced stages of cirrhosis and are associated with increased mortality due to their potential for rupture and bleeding. The aim of this study is to examine the accuracy of a surrogate marker, Mac-2 binding protein glycosylation isomer (M2BPGi), for screening high-risk esophageal varices in cirrhotic patients. Methods: Ninety-four cirrhotic patients who underwent endoscopy screening at Cipto Mangunkusumo Hospital, Jakarta, Indonesia were included. Patients with a history of ligation, portal vein thrombosis, or hepatocellular carcinoma were excluded. All enrolled patients underwent ultrasonography, transient elastography, and laboratory tests. The HISCL-5000 Sysmex analyzer was used to measure M2BPGi levels. Results: Of these 94 patients, 27 had high-risk esophageal varices and 67 had non-high-risk esophageal varices. M2BPGi levels were higher in patients with high-risk esophageal varices compared with those with non-high-risk esophageal varices (cutoff index (COI) of 11.4 vs. 3.7, p < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of M2BPGi with a cutoff value of 5 COI was 92.6%, 70.1%, 55.6%, and 95.9%, respectively. Conclusions: M2BPGi could be used as a non-invasive surrogate marker for ruling out high-risk esophageal varices in cirrhotic patients. This method is cheap and non-invasive and could be used as a screening tool in resource-limited settings.

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The Role of Spleen Stiffness in Determining the Severity and Bleeding Risk of Esophageal Varices in Cirrhotic Patients

Medicine ◽

10.1097/md.0000000000001031 ◽

2015 ◽

Vol 94 (24) ◽

pp. e1031 ◽

Cited By ~ 19

Author(s):

Hwi Young Kim ◽

Eun Hyo Jin ◽

Won Kim ◽

Jae Young Lee ◽

Hyunsik Woo ◽

...

Keyword(s):

Esophageal Varices ◽

Bleeding Risk ◽

Spleen Stiffness ◽

Cirrhotic Patients

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Soluble CD163 for Prediction of High-Risk Esophageal Varices and Variceal Hemorrhage in Patients with Liver Cirrhosis

GE Portuguese Journal of Gastroenterology ◽

10.1159/000516913 ◽

2021 ◽

pp. 1-14

Author(s):

Mohamed Yousri Taher ◽

Abeer El-Hadidi ◽

Assem El-Shendidi ◽

Ahmed Sedky

Keyword(s):

High Risk ◽

Esophageal Varices ◽

Bleeding Risk ◽

Primary Prophylaxis ◽

Variceal Hemorrhage ◽

Cutoff Value ◽

Soluble Cd163 ◽

Acute Upper Gastrointestinal Bleeding ◽

Cirrhotic Patients ◽

Surveillance Endoscopy

Introduction: Activation of hepatic macrophages in liver disease is pathogenically related to portal hypertension (PH). Soluble CD163 (sCD163) is shed in blood by activated macrophages and may predict PH progression noninvasively. This study was designed to investigate the relation of serum sCD163 to the grade and bleeding risk of esophageal varices (EV) and its role for prediction of variceal hemorrhage (VH). Methods: The study included cirrhotic patients divided into 3 groups: patients who presented with acute upper gastrointestinal bleeding (UGIB) proved to originate from EV on endoscopy, patients without any history of UGIB but who revealed EV on surveillance endoscopy, and patients without endoscopic evidence of varices. Variceal grade and risk signs and bleeding stigmata were noted simultaneously with measurement of serum sCD163 concentration. Results: Serum sCD163 concentration showed a significant increase in cirrhotic patients compared to healthy subjects (p < 0.001) with a stepwise increase among the group without varices, nonbleeder group, and bleeder group sequentially. Serum sCD163 levels correlated positively with the variceal grade and risk signs in both the bleeder and nonbleeder groups (p = 0.002, p < 0.001 and p = 0.004, p < 0.001, respectively). Serum sCD163 at a cutoff value of 3.6 mg/L performed significantly for prediction of EV presence (AUC = 0.888). Serum sCD163 at a cutoff value >4 mg/L significantly predicted large-size and high-risk EV (AUC = 0.910 and AUC = 0.939, respectively) and the index bleed risk (AUC = 0.977). Serum sCD163 at a cutoff value >4.05 mg/L modestly discriminated bleeding EV from those that had never bled (AUC = 0.811). Conclusions: Serum sCD163 levels accurately predicted high-grade and high-risk EV and could help plan for primary prophylaxis. However, it modestly identified VH occurrence, and endoscopy would be required to make a definitive diagnosis.

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Forns index as a useful noninvasive predictor of esophageal varices in liver cirrhosis

Zinc supplementation improves heme biosynthesis in rats exposed to lead ◽

10.18051/univmed.2016.v35.199-205 ◽

2016 ◽

Vol 35 (3) ◽

pp. 199

Author(s):

Rizqi Arini Siregar ◽

Leonardo Basa Dairi ◽

Gontar Alamsyah Siregar

Keyword(s):

Esophageal Varices ◽

Predictive Value ◽

Cross Sectional Study ◽

Serum Markers ◽

Likelihood Ratios ◽

Cross Sectional ◽

Significant Difference ◽

Cirrhotic Patients ◽

The Difference ◽

Sensitivity Specificity

Background Rupture and bleeding from esophageal varices are major complications of portal hypertension and associated with a high mortality rate. Non-invasive serum markers of liver fibrosis could be used as predictors of esophageal varices in cirrhotic patients. The objective of this study was to assess the performance of Forns index as a noninvasive predictor in diagnosing esophageal varices. Methods A cross-sectional study was done in 51 cirrhotic patients who were admitted to Adam Malik hospital, Medan. Demographic and clinical data were recorded and laboratory tests were performed, so that Forns index could be calculated. The difference between Forns index and size of esophageal varices as determined by endoscopy was tested by independent-t and Mann-Whitney analysis. The diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, likelihood ratios and areas under the receiver operating characteristic curves (AUROC). Results Of the 51 patients with esophageal varices included in this study, the size of esophageal varices comprised F2 (37.3%), F3 (33.3), and F1 (29.4%). Most patients were of Child-Plug C type (52.6%). There was a significant difference between Forns index and grade of esophageal varices. The AUROC for Forns index was 0.717 (95% CI: 0.561 - 0.872) and the cut-off >7.92 was highly predictive to diagnose large esophageal varices with a sensitivity of 63.9%, specificity of 73.3%, PPV of 85.2%, NPV of 45.8% and accuracy of 71.7%. Conclusion Forns index was significantly increased in large esophageal varices. Forns index is a good noninvasive predictor of esophageal varices in cirrhotic patients.

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DOPPLER STUDY OF SPLENIC ARTERY AND RENAL ARTERY RESISTIVE INDEX AS A PREDICTIVE OF ESOPHAGEAL VARICES AND ITS BLEEDING RISK IN EGYPTIAN CIRRHOTIC PATIENTS

Al-Azhar Medical Journal ◽

10.12816/0052820 ◽

2018 ◽

Vol 47 (3) ◽

pp. 587-602

Author(s):

Shaban Salah Al-Azhary ◽

Samy Zaky ◽

Abdullah Hussein Ahmed ◽

Mahmoud Hagag Abd El Fadeel

Keyword(s):

Renal Artery ◽

Esophageal Varices ◽

Splenic Artery ◽

Resistive Index ◽

Bleeding Risk ◽

Doppler Study ◽

Cirrhotic Patients

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CT hepatic arterial perfusion index does not allow stratification of the degree of esophageal varices and bleeding risk in cirrhotic patients in Child–Pugh classes A and B

Abdominal Radiology ◽

10.1007/s00261-021-03259-6 ◽

2021 ◽

Author(s):

Felix Peisen ◽

Kaspar Ekert ◽

Michael Bitzer ◽

Hans Bösmüller ◽

Jan Fritz ◽

...

Keyword(s):

Liver Cirrhosis ◽

Correlation Coefficient ◽

Esophageal Varices ◽

Bleeding Risk ◽

Perfusion Index ◽

Arterial Perfusion ◽

Class A ◽

Significant Difference ◽

Pugh Class ◽

Cirrhotic Patients

Abstract Purpose To evaluate if the hepatic arterial perfusion index (HPI) in liver parenchyma of cirrhotic patients can serve as a surrogate parameter for stratifying the degree of esophageal varices and related bleeding risks. Methods CT image data of sixty-six patients (59 men; mean age 68 years ± 10 years) with liver cirrhosis (Child–Pugh class A (35/66, 53%), B (25/66, 38%), and C (6/66, 9%) who underwent perfusion CT (PCT) for hepatocellular carcinoma (HCC) screening between April 2010 and January 2019 were retrospectively identified. HPI, a parameter calculated by a commercially available CT liver perfusion analysis software that is based on the double maximum slope model, using time attenuation curve to determine perfusion, was correlated with the degree of esophageal varices diagnosed at endoscopy and the number of bleeding events. Results Eta correlation coefficient for HPI/presence of esophageal varices was very weak (0.083). Spearman-Rho for HPI/grading of esophageal varices was very weak (0.037 (p = 0.804)). Kendall-Tau-b for HPI/grading of esophageal varices was very weak (0.027 (p = 0.807)). ANOVA and Bonferroni post-hoc-tests showed no significant difference of HPI between different grades of esophageal varices (F (3, 62) = 1.676, p = 0.186). Eta correlation coefficient for HPI/bleeding event was very weak (0.126). Conclusion The stratification of the degree of esophageal varices and the related bleeding risk by correlation with the HPI as a surrogate parameter for portal venous hypertension was not possible for patients with liver cirrhosis in Child–Pugh class A and B. Graphic abstract

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