scholarly journals Prediction of esophageal varices in liver cirrhosis by transient elastography and aspartate aminotransferase - to - platelet ratio index (APRI)

2018 ◽  
Vol 6 (1) ◽  
pp. 16-21
Author(s):  
Debashis Kumar Sarkar ◽  
Golam Azam ◽  
Majharul Haque ◽  
Anisur Rahman
Keyword(s):  
Liver Cirrhosis ◽  
Complete Blood Count ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Variceal Hemorrhage ◽  
Cutoff Value ◽  
Liver Injuries ◽  
Cirrhotic Patients ◽  
Cirrhosis Of Liver ◽  
Almost All

Background: Cirrhosis is a chronic liver disease that can be caused by almost all progressive liver injuries, such as viral, autoimmune, hereditary, metabolic and toxin mediated liver diseases. Esophageal varix (EV) is a frequent complication of cirrhosis. Although the survival rate of patients with bleeding cirrhosis has improved because of the progress in variceal hemorrhage management, the hospital mortality rate is still around 14.5% cases. Early detection of EV in all patients with liver cirrhosis is required in order to reduce the mortality.Method: This observational study was done at department of Gastrointestinal, Hepatobiliary & Pancreatic Disorders (GHPD), BIRDEM General Hospital, Dhaka, during the period of August 2015 to October 2016. A total of 65 patients with cirrhosis of liver were included. Complete blood count, liver function test, endoscopy of upper GIT, ultrasonography, transient elastogram were done for all patients. Statistical analysis was done with SPSS version 22.Result: The study included 65 cirrhotic patients, among them 66.2 % were male. The mean age was 53.8 years. For predicting EVs, transient elastography at a cutoff value of 18 kpa demonstrated a sensitivity was 88.7% (95% CI=82.3-92.7), specificity 75.0% (95% CI=46.9-92.6), PPV 94.0% (95% CI=87.2-98.2), NPV 60.0% (95% CI= 37.5 -74.0), AUC was 0.769. In APRI for prediction of EVs at cutoff value 1.00, sensitivity was 63.3% (95% CI=55.6-65.4), specificity 83.3.0% (95% CI=53.7-97.0), PPV 94.3% (95% CI=84.1-99.0), NPV 33.3% (95%CI=21.5-38.8) and AUC was 0.779.Conclusion: A significant positive correlation found between transient elastography with EVs in cirrhotic patients. Liver stiffness value at 18 Kpa can predict EVs in cirrhotic patients. On contrary, APRI had a less(negative predictive value) NPV that showed there is no satisfactory cutoff value for APRI to be used as a predictor of EVs.Bangladesh Crit Care J March 2018; 6(1): 16-21

scholarly journals “SPLEEN STIFFNESS MEASUREMENT IN LIVER CIRRHOSIS PATIENTS FOR NONINVASIVE ASSESSMENT OF ESOPHAGEAL VARICES USING FIBROSCAN”

2020 ◽  
pp. 1-2
Author(s):  
Revathy Marimuthu Shanmugam ◽  
Vinay C ◽  
Sathya Gopalasamy ◽  
Chitra Shanmugam
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Esophageal Varix ◽  
Esophageal Varices ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Surrogate Marker ◽  
Stiffness Measurement ◽  
Spleen Stiffness ◽  
Cirrhotic Patients

BACKGROUND: Many noninvasive surrogate marker for Portal hypertension or for the presence or grade of esophageal varices were studied..Splenomegaly along with splenic congestion secondary to splenic hyperdynamic circulation is seen secondary to Portal hypertension in cirrhotic patients that can be quantified by elastography. AIM:The aim of this study was to investigate whether spleen stiffness, assessed by TE, useful tool for grading chronic liver diseases and to compare its performance in predicting the presence and size of esophageal varices in liver cirrhosis patients. METHODOLOGY:86 patients with cirrhosis and 80 controls underwent transient elastography of liver and spleen for the assessment of liver stiffness (LSM) and spleen stiffness (SSM) . Upper GI endoscopy done in all Cirrhotic patients. RESULTS: Spleen stiffness showed higher values in liver cirrhosis patients as compared with controls: 58.2 kpa vs14.8 kpa (P < 0.0001) and also found to be significantly higher in cirrhotic patients compared with varices and those without varices (69.01 vs 42.05 kpa, P < 0.0001). Liver stiffness was also found to be higher in cirrhotic patients with varices when compared to patients without varices (38.5vs 21.2 kpa). Using both liver and spleen stiffness measurement we can predicted the presence of esophageal varices correctly. CONCLUSION: Spleen stiffness can be assessed using transient elastography, higher value correlated well with liver cirrhosis and presence of esophageal varices although it couldn’t correlate with grade of Esophageal Varix. Combined assessment of spleen and liver stiffness had better prediction of presence of Esophageal Varix.

scholarly journals Assessment of Spleen Stiffness for Prediction of Varices in Patients with Hepatitis C Related Cirrhosis Using Transient Elastography

2020 ◽  
pp. 9-18
Author(s):  
Naglaa El-Toukhy Ramadan El-Toukhy ◽  
Sharaf Elsayed Ali Hassanien ◽  
Ramy A. Metwaly ◽  
Medhat A. Khalil ◽  
Badawy A. Abdulaziz
Keyword(s):  
Liver Cirrhosis ◽  
Hepatitis C ◽  
Esophageal Varices ◽  
Predictive Value ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Diagnostic Value ◽  
Group I ◽  
Spleen Stiffness ◽  
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.

scholarly journals Value of hepatic elastography and Doppler indexes for predictions of esophageal varices in liver cirrhosis

2015 ◽  
Vol 17 (1) ◽  
pp. 5 ◽  
Author(s):  
Adriana Bintintan ◽  
Romeo Ioan Chira ◽  
Vasile Virgil Bintintan ◽  
Georgiana Nagy ◽  
Roberta Maria Manzat-Saplacan ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Esophageal Varices ◽  
Statistical Power ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Abdominal Ultrasound ◽  
Non Invasive ◽  
Cirrhotic Patients ◽  
Ultrasound Parameters

Aims: Non-invasive methods are required to diagnose presence and grading of esophageal varices in patients with he- patic cirrhosis and in this respect we have evaluated the role of transient elastography and abdominal ultrasound parameters. Material and methods: Cirrhotic patients were prospectively evaluated by transient elastography and Doppler ultrasound for diagnosis of presence and grading of esophageal varices, the results being compared with the findings of the esophagogas- troduodenoscopy. Results: Sixty patients with hepatic cirrhosis were analysed. The parameters that reached statistical signifi- cance for diagnosis of esophageal varices were: liver stiffness (LSM) > 15 kPa, hemodynamic liver index (PVr1) ≥ 0.66, portal vascular resistance (PVR) > 17.66 and splenoportal index (SPI) > 4.77. The only parameter that reached statistical power for the diagnosis of large esophageal varices was LSM at a cut-off value of 28.8 kPa. Conclusions: Assessment of LSM in patients with liver cirrhosis can predict both the presence of esophageal varices and of large esophageal varices. The PVr1, PVR and SPI Doppler indexes can be used to diagnose the presence of esophageal varices but have no role in the prediction of large esophageal varices. Further studies are required to confirm these results and offer a stronger clinical significance.

scholarly journals The potential role of Transient Elastography in assessing patients with Primary Budd Chiari Syndrome

2020 ◽  
Author(s):  
Muriel Webb ◽  
Oren Shibolet ◽  
Yoav Lurie ◽  
Yakov Maor ◽  
Helena Katchman ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Potential Role ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Abdominal Ultrasound ◽  
P Value ◽  
Budd Chiari Syndrome ◽  
Chiari Syndrome ◽  
Cirrhotic Patients

Abstract Background: Budd-Chiari syndrome (BCS) is a rare disease defined as hepatic venous outflow obstruction at any level from the hepatic venules up to the cavo-atrial junction. Transjugular Intrahepatic Portosystemic Shunt (TIPS) is performed as a decompressive treatment in some patients.Aim: To evaluate the potential role of Transient Elastography (TE) in assessing liver stiffness in patients with primary BCS.Methods: Twenty one BCS patients and 10 patients with liver cirrhosis with different underlying etiologies underwent abdominal ultrasound and TE.Results: Ninety-five percent of BCS patients had liver stiffness compatible with F4 with a median of 21 kPa, values which are usually obtained in patients with liver cirrhosis. Ten BCS and 10 cirrhotic patients underwent repeated TE with a median of 320 days between exams for BCS and 4.5 years for cirrhotic patients. The change of liver stiffness in BCS patients was 5.75 kPa (range − 0.4 to 26.6), compared with − 4.85 kPa (range − 15.6 to 15.0) in cirrhotic patients (p-value = 0.0029). Change in liver stiffness from baseline to follow-up in BCS patients who underwent TIPS (n = 4) was 0.2 kPa (range − 0.4 to 15.3), whereas in patients without intervention (n = 6) it was 6.75 kPa (range 1.3 to 26.6). The difference was not statistically significant.Conclusion: Liver stiffness in BCS patients is a dynamic progressive process with parameters of TE resembling liver cirrhosis. Even if TIPS seem to slow down the increment of liver stiffness, because of decreased liver congestion, it kept most patients with high score. The TE in BCS patients may be considered for monitoring for stable or upfront disease deterioration.

scholarly journals Validation of the Combined Model Based on Platelet Count and Albumin to Rule out High-Risk Varices in Liver Cirrhosis

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Zhihui Duan ◽  
Li Li ◽  
Jinlong Li ◽  
Shengyun Zhou
Keyword(s):  
Platelet Count ◽  
High Risk ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Hepatitis B Infection ◽  
Combined Model ◽  
Blood Tests ◽  
Compensated Cirrhosis ◽  
Cirrhotic Patients ◽  
Rule Out

Background. The Baveno VI criteria based on platelet count and liver stiffness, measured by transient elastography (TE), have been proposed to rule out high-risk varices (HRV) defined as medium or large-sized varices or the presence of high-risk stigmata (cherry red spots and red wale marks). However, TE is not available in all hospitals. Recently, the Rete Sicilia Selezione Terapia hepatitis C virus (RESIST-HCV) criteria recommended that cirrhotic patients with a platelet count>120000/μL and serum albumin>36 g/L could avoid esophagogastroduodenoscopy (EGD) screening for HRV. Aim. We aimed to validate the performance of the RESIST-HCV criteria in two cohorts predominantly characterized with hepatitis B infection. Methods. Patients with compensated cirrhosis who had blood tests within three months of performing EGD and TE were enrolled retrospectively from two centers. RESIST-HCV criteria were applied to identify patients who did not require EGD screening. Results. This study included 188 patients from the Xingtai cohort (28 (14.9%) with HRV) and 104 patients from the Beijing cohort (19 (18.3%) with HRV). Of the patients who met the RESIST-HCV criteria (83 in the Xingtai cohort and 26 in the Beijing cohort), 0 and 1 had HRV, respectively, accounting for 44.1% (Xingtai cohort) and 25% (Beijing cohort) of endoscopies that were unnecessary. In the combined cohort, 109 (37.3%) patients met the RESIST-HCV criteria, only 1 (0.9%) HRV was missed, and the negative predictive value was 99.1%. Baveno VI and Expanded Baveno VI criteria spared 15.6% and 23.3% of EGDs, respectively, while missing 0% and 4.8% of HRV, respectively. Conclusions. In our population, the combined criteria based on platelet count and serum albumin performed well, saving 30-40% of EGDs and correctly identifying 99.1% of patients who could safely avoid screening endoscopies for high-risk varices in compensated cirrhotic patients.

scholarly journals Lifestyle, Nutritional Status and Seroclinical Profile of Liver Cirrhotic Patients

1970 ◽  
Vol 36 (2) ◽  
pp. 44-47
Author(s):  
Touhida Ahsan ◽  
Monira Ahsan ◽  
Md Mustafa Kamal ◽  
Kaji Jahangir Hossain ◽  
Mohammed Emdadul Haque ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Nutritional Status ◽  
Energy Intake ◽  
Clinical Signs ◽  
College Hospital ◽  
Housing Status ◽  
Medical College ◽  
Cirrhotic Patients ◽  
Almost All ◽  
Medical University

Liver cirrhotic patients were investigated for their lifestyle, energy intake, BMI, biochemical and serological indices and prevalent clinical signs. The study included 50 liver cirrhotic patients who were hospitalized in Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital and BIRDEM Hospital during the period of 1999-2000. Of the fifty cirrhotic patients, hepatitis B virus infection was found responsible for 52% (n=26) of liver cirrhosis, hepatitis C was for only 6% (n=3) patients and etiology for the rest 42% (n=21) patients could not be identified. It was observed that literate, low-mid income and productive male were being suffering from the liver cirrhosis. The patients had good housing status. Low energy intake (1670.6±42.9) and low BMI (19.52±3.48) were present in almost all of the patients. Mean serum haemoglobin, total proteins, and albumin were 96.2±20.5g/L, 63.1±1.01g/L, and 31.30±0.93g/L respectively. Serum bilirubin was raised in 50% patients. Serum SGPT and SGOT levels were increased from 2 to 4 folds in 50% of the patients; alkaline phosphatase was increased only in 8% cirrhotic patients. Anaemia, PEM, ascities, oedema, muscle wasting were prevalently present in vast majority of the patients. Key words: Liver cirrhosis, nutritional status, liver function determinants   DOI: 10.3329/bmj.v36i2.3611 Bangladesh Medical Journal 36(2) 2007 44-47

scholarly journals Systemic Mastocytosis: A Rare Case of Increased Liver Stiffness

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Stefanie Adolf ◽  
Gunda Millonig ◽  
Helmut Karl Seitz ◽  
Andreas Reiter ◽  
Peter Schirmacher ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Histological Analysis ◽  
Transient Elastography ◽  
Systemic Mastocytosis ◽  
Liver Stiffness ◽  
Abdominal Ultrasound ◽  
Bone Lesions ◽  
Non Invasive ◽  
Liver Specimen ◽  
Clinical Algorithms

Assessment of liver stiffness (LS) by transient elastography (Fibroscan) has significantly improved the noninvasive diagnosis of liver fibrosis. We here report on a 55-year-old patient with drastically increased LS due to previously unknown systemic mastocytosis. The patient initially presented with increased weight loss, nocturnal pruritus, increased transaminases, bilirubinemia, and thrombocytopenia. Abdominal ultrasound showed ascites, hepatomegaly, and splenomegaly. In addition, LS was 75 kPa (IQR 0 kPa) clearly exceeding the cut-off value for F4 cirrhosis of 12.5 kPa. However, histological analysis of the liver specimen indicated liver involvement by systemic mastocytosis and excluded liver cirrhosis. An additional CT scan detected disseminated bone lesions. After three months of treatment with Midostaurin, LS slightly decreased down to 31.9 kPa (IQR 8.3 kPa). This case illustrates that diffused sinusoidal neoplastic infiltrates are a pitfall in the non-invasive diagnosis of liver cirrhosis. In conclusion, refined clinical algorithms for increased LS should also include mastocytosis in addition to inflammation, congestion, and biliary obstruction.

scholarly journals Significance of Non-Invasive Markers as Predictor of Esophageal Varices in Liver Cirrhosis

2017 ◽  
Vol 56 (208) ◽  
pp. 412-6 ◽  
Author(s):  
Dipendra Khadka ◽  
Sushil Prajapati ◽  
Sudhamshu KC ◽  
Jeetendra Kaji Shrestha ◽  
Niyanta Karki ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Platelet Count ◽  
Esophageal Varices ◽  
Complete Blood Count ◽  
Clinical Expertise ◽  
Spleen Size ◽  
Cross Sectional ◽  
Cutoff Value ◽  
Non Invasive ◽  
Pugh Class

Introduction: Upper gastro-intestinal endoscopy remains the gold standard for screening for esophageal varices but it has its own limitations. It is an invasive, expensive and uncomfortable procedure and needs clinical expertise. Accordingly, this study was conducted to establish the role of non-invasive markers for prediction of esophageal varices in liver cirrhosis. Methods: A hospital based descriptive cross-sectional study was carried out in Liver unit of National Academy of Medical Sciences, Bir Hospital, from October 2016 to September 2017. Complete blood count, liver function test, liver ultrasound and upper gastro-intestinal endoscopy were done for all patients to detect esophageal varices and to correlate with different non-invasive markers. Results: Total 191 patients of liver cirrhosis were studied after exclusion. Platelet count of 92082.00±43435.83/mm3 and spleen size of 144.21±10.71 mm was found to be good predictors of presence of EV (P≤0.001). Significant association between Child-Turcotte-Pugh class and presence of varices was observed (P≤0.001). AST/ALT ratio with cutoff value of 1.415 showed sensitivity of 82.4% and specificity of 36.4%. APRI at a cutoff value of 1.3 showed a sensitivity of 83.2% and specificity of 50%. Conclusions: Platelet count, spleen size and Child-Turcotte-Pugh class are good predictors of presence of esophageal varices in patients with liver cirrhosis. AST/ALT ratio and APRI score are not good substitutes for upper gastro-intestinal endoscopy.   Keywords:  esophageal varices; liver cirrhosis; non-invasive markers; portal hypertension; upper gastro-intestinal.

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