Non Invasive Prediction of Varices in Egyptian Cirrhotic Patients
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- Category: Vol. 77, June 2009
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Non Invasive Prediction of Varices in Egyptian Cirrhotic Patients,AYMAN YOSRY, RBAB FOUAD, MOHAMAD ABDEL BARY, SHERIF HAMDY, MOHAMAD MAHMOUD and MARWA KHAIRY
Abstract
Background and Study Aims: Cirrhotic patients frequently undergo screening endoscopy for the presence of varices. In the future, this social and medical burden will increase due to the greater number of patients with chronic liver disease and their improved survival. In this study, our aim was to develop a predictive model using independent risk factors for the presence of varices in the enrolled patients.
Patients and Methods: 200 patients with liver cirrhosis with no history of variceal haemorrhage were subjected to clinical examination; laboratory investigations (CBC, Liver biochemical profile, serum urea and creatinine), modified Child-Pugh score and MELD score were calculated. Abdominal ultrasonography and Doppler study of the portal and splenic veins studying the liver size, the presence of periportal thick-ening, hepatic veins flow pattern, the splenic longest axis and volume, the presence of ascites and collaterals. Portal vein and splenic vein diameter, patency, cross sectional area, mean flow velocity, blood flow volume congestion index and direc-tion of flow of portal vein were calculated. Platelets count/Splenic diameter ratio and Right liver lobe diameter/ albumin ratio were calculated for all patients. Upper endoscopy was done where oesophageal varices were graded according to modified Thakeb classification.
Results: This study revealed that 83% of patients had oesophageal varices; 52% had small sized oesophageal varices and 31% had large sized oesophageal varices. In patients with varices; 12% had biphasic and 22.9% had monophasic hepatic veins flow pattern, with p value of 0.002. Portal vein direction of flow was bidirectional in 22.9% and Hepatofugal in 9.6% with a p value of 0.004. The portal vein velocity of 9.3±2.3cm/ sec with a p value of <0.001 and the ascites was present in 77% of patients with a p value of 0.005. In patients with large sized varices; shrunken liver was present in 83.1 % of patients with a p value of 0.005 and serum albumin <2.5gm/dl with a p value of 0.008.
Conclusion: Hepatic veins flow pattern (biphasic and monophasic), portal vein direction of flow (hepatofugal and bidirectional), decreased portal vein velocity and the presence of ascites (moderate and marked) were the significant variables for prediction of presence of varices. Shrunken liver and the low serum albumin were the significant variables for prediction of large varices.