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Tivaskar S, Dhande R, Mishra GV, Luharia A, Naik S, Varghese AP, Asrar Ul Haq Andrabi S. Esophageal Varices Presenting With Massive Hematemesis in a Chronic Alcoholic: A Case Report on a Rare Condition. Cureus 2024; 16:e63889. [PMID: 39104992 PMCID: PMC11298274 DOI: 10.7759/cureus.63889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 07/05/2024] [Indexed: 08/07/2024] Open
Abstract
Esophageal varices are life-threatening complications in which the enlargement of the esophageal veins causes bleeding and reduces blood flow to the esophagus. They are complications caused by portal hypertension, renal failure, hepatic dysfunction, and infection. The leading cause of esophageal varices is cirrhosis, as patients with this disease are more susceptible to forming esophageal varices. Bleeding episodes occur due to the rupture of the blood vessels. We present the case of a 45-year-old male patient in the hospital with a history of chronic alcohol use and clinical symptoms of hematemesis, a distended abdomen, and melena. The patient experienced mild symptoms of giddiness and dizziness after undergoing various radiological investigations, laboratory tests, ultrasonography (USG), and CT scans. USG diagnosed portal hypertension, gross ascites, pleural effusion, and hepatosplenomegaly. A CT scan diagnosed the patient with esophageal varices and testicular carcinoma. Laboratory tests diagnosed anemia. The treatment plan included oral and intravenous iron supplements, blood transfusions, vitamin B12, folate supplements, and nonselective beta-blockers to manage portal hypertension and reduce variceal bleeding risk. During acute bleeding episodes, vasoconstrictors and endoscopic band ligation were employed. Regular endoscopies and hepatic venous catheterization were conducted to monitor and manage the condition. Follow-up included regular assessments of hemoglobin levels, iron status, liver function tests, and periodic endoscopies. The patient's adherence to beta-blockers was closely monitored. Esophageal varices, often resulting from portal hypertension because of cirrhosis, require early diagnosis and a combination of pharmacological and endoscopic treatments to prevent complications. Advances in treatment have reduced mortality rates, but effective management of portal hypertension and liver dysfunction remains crucial.
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Affiliation(s)
- Suhas Tivaskar
- Radiology, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Rajasbala Dhande
- Radiodiagnosis, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Gaurav V Mishra
- Radiodiagnosis, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Anurag Luharia
- Radiology, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Shreya Naik
- Radiology, School of Allied Health Sciences, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Albert P Varghese
- Radiology, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Gebregziabiher HT, Hailu W, Abay Z, Bizuneh S, Meshesha MD. Accuracy of non-invasive diagnosis of esophageal varices among cirrhotic patients in a low-income setting. Heliyon 2023; 9:e23229. [PMID: 38149190 PMCID: PMC10750066 DOI: 10.1016/j.heliyon.2023.e23229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 11/25/2023] [Accepted: 11/29/2023] [Indexed: 12/28/2023] Open
Abstract
Cirrhosis is a chronic liver disease that is frequently complicated by increased portal venous pressure and the formation of EV. The most common clinical manifestation of portal hypertension is esophageal varices, and ruptured varices are the most fatal complication of portal hypertension. The diagnosis and follow-up of esophageal varices is done by Esophagogastroduodenoscopy, but in most developing countries, the follow-up of cirrhotic patients by gastrointestinal endoscopy remains a challenge. Objective Assessment of diagnostic accuracy of noninvasive tests as predictors of esophageal varices among cirrhotic patients at University of Gondar comprehensive Hospital. Method Institution based cross-sectional study was conducted among cirrhotic patients from March 2022-October 2022. All study participants underwent screening for Esophageal Varices, Spleen Diameter, Platelet count and Platelet count/spleen diameter ratio. Data were analyzed using SPSS version 26. ROC curves were plotted for Spleen Diameter, Platelet count and Platelet count/spleen diameter ratio with specific cutoffs determined. Diagnostic performance was assessed using ROC curve. The diagnostic thresholds were specified with their sensitivity, specificity, positive predictive value, negative predictive value positive and negative likelihood ratios. Result A total of 206 patients were included. The mean age was 41.84 year and SD of (41.84 ± 12.398). About 79.4 % percent were males. Endoscopy confirmed esophageal varices were present in 176(85.4 %) cases. Sixty-seven percent of cases had decompensated cirrhosis (Child-Pugh class B&C). The platelet count to spleen diameter ratio less than 818 had a PPV of 94.7 % (AUROC = 0.835), while spleen diameter greater than 145 mm had 93.7 % PPV (AUROC = 0.783). At a platelet count cutoff <121,000/mm3, the PPV was 95.1 % (AUROC = 0.818). Conclusion In this study, platelet count, spleen diameter, and PC/SD all performed well for EV diagnostics, with PC/SD outperforming the others. This finding supports the use of these noninvasive indicators for the diagnosis and implementation of prophylactic treatment foe esophageal varices in health institutions where gastrointestinal endoscopy is unavailable.
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Affiliation(s)
| | | | - Zenahebezu Abay
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Segenet Bizuneh
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
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Wei M, Chen Y, Wang M, Li J, Zeng Y, Sun X, Zhang A, Liu X, Zhou T, Gao Y. Partial splenic embolization combined with endoscopic therapies and vasoconstrictive drugs reduces rebleeding in cirrhosis patients with acute variceal bleeding and hypersplenism: a multicenter randomized controlled trial. J Gastroenterol 2023; 58:1144-1153. [PMID: 37486372 DOI: 10.1007/s00535-023-02027-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/14/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND This study aimed to compare the efficacy of partial splenic embolization (PSE) combined with endoscopic therapy and endoscopic therapy alone in cirrhosis patients with acute variceal bleeding (AVB) and hypersplenism. METHODS Cirrhosis patients with AVB who visited three hospitals from June 2016 to June 2022 were prospectively enrolled and randomly allocated to either the endoscopic therapy combined with PSE group (EP group) or the endoscopic intervention group (E group) in a 1:1 ratio. The primary endpoint of the study was re-bleeding of varices during follow-up, and the secondary endpoints were the recurrence of varices, death, and adverse events. RESULTS One hundred and fourteen patients were prospectively included, of whom 110 completed the trial. The risk of variceal re-bleeding (19.3% vs. 40.4% (23/57), p = 0.013) and variceal recurrence (28.1% vs. 63.2%, p < 0.001) five years after treatment was significantly lower in the EP group than in the E group, and the EP treatment was the only significant independent risk factor affecting variceal re-bleeding and variceal recurrence in patients. The mortality rate was comparable between the EP and E groups. Peripheral blood counts and liver function all improved significantly in the EP group compared to the E group during the follow-up (p < 0.05). CONCLUSIONS The rates of variceal re-bleeding and recurrence were significantly lower in cirrhosis patients with AVB and hypersplenism after combined endoscopic and PSE treatment compared to those who were provided endoscopic treatment only. The peripheral blood counts and liver function were also improved significantly in EP group (NCT02778425).
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Affiliation(s)
- Min Wei
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yong Chen
- Department of Gastroenterology, Shandong Provincial Hospital, Jinan, Shandong, China
| | - Minghui Wang
- Department of Gastroenterology, The 960th Hospital of the Chinese People's Liberation Army, Jinan, Shandong, China
| | - Jinhou Li
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Department of Gastroenterology, Taian City Central Hospital, Taian, Shandong, China
| | - Yunqing Zeng
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xin Sun
- Department of Gastroenterology, Central Hospital Affiliated of Shandong First Medical University, Jinan, Shandong, China
| | - Anzhong Zhang
- Department of Gastroenterology, Shandong Provincial Hospital, Jinan, Shandong, China
| | - Xiaofeng Liu
- Department of Gastroenterology, The 960th Hospital of the Chinese People's Liberation Army, Jinan, Shandong, China
| | - Tao Zhou
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China.
- Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital of Shandong University, Jinan, Shandong, China.
| | - Yanjing Gao
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
- The Institute of Portal Hypertension, Shandong University, Jinan, Shandong, China.
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Liu H, Zhang Q, Gao F, Yu H, Jiang Y, Wang X. Platelet Count/Spleen Thickness Ratio and the Risk of Variceal Bleeding in Cirrhosis With Esophagogastric Varices. Front Med (Lausanne) 2022; 9:870351. [PMID: 35911391 PMCID: PMC9329511 DOI: 10.3389/fmed.2022.870351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/10/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionThe platelet count/spleen thickness ratio (PC/ST ratio) is associated with the grade of esophagogastric varices (EGV) in cirrhotic patients, but little is known about its relationship with esophagogastric variceal bleeding (EGVB). The aim of this study was to investigate the association between the PC/ST ratio and the risk of EGVB within 1 year in cirrhotic patients.MethodsA total of 1,354 patients with cirrhosis who had EGV were enrolled in this cohort study. A logistic regression model was used to determine the association between the PC/ST ratio and the risk of EGVB within 1 year in patients with cirrhosis by adjusting the PC/ST ratio with all the important clinical variables and confounders.ResultsThe quartile values of the PC/ST ratio were 1.01, 1.36, and 1.98, respectively. The PC/ST ratio was an independent risk factor for variceal bleeding in cirrhotic patients with moderate or severe EGV. After adjusting for multiple variables, the relationship was still unchanged. The odds ratios of the first EGVB in these patients were 5.07-fold at non-adjustment and 3.28-fold after multivariate adjustment. The odds ratios of rebleeding in these patients from the lowest to the highest quartile were 2.34-fold at non-adjustment and 2.01-fold after multivariable adjustment. The PC/ST ratio ≤ 1.36 elevated the 1-year risk of first-time variceal bleeding or rebleeding in cirrhotic patients with moderate or severe EGV (All P < 0.05).ConclusionThe PC/ST ratio ≤ 1.36 is an independent risk factor for the onset of first bleeding or rebleeding in cirrhotic patients with moderate or severe EGV.
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Affiliation(s)
- Huimin Liu
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Department of Traditional Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Qun Zhang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Fangyuan Gao
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hao Yu
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yuyong Jiang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yuyong Jiang,
| | - Xianbo Wang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Xianbo Wang,
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Sami SS, Harman D, Ragunath K, Böhning D, Parkes J, Guha IN. Non-invasive tests for the detection of oesophageal varices in compensated cirrhosis: systematic review and meta-analysis. United European Gastroenterol J 2018; 6:806-818. [PMID: 30023058 PMCID: PMC6047293 DOI: 10.1177/2050640618767604] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 02/27/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Conclusive data on the accuracy and clinical applicability of non-invasive screening tests for oesophageal varices (OV) in patients with compensated cirrhosis remain lacking. We conducted this study to identify currently available tests, estimate their diagnostic performance and then exemplify how these could be utilized in clinical practice. MATERIALS AND METHODS A systematic literature search was performed to identify all primary studies that reported accuracy using oesophagogastroduodenoscopy (OGD) as the gold standard. Sources searched included Ovid MEDLINE, Ovid EMBASE and The Cochrane Library databases. RESULTS Twenty-one studies with a total of 2471 patients were identified. Several tests were evaluated in more than three studies. Platelet count/spleen diameter ratio (PSR) had the highest summary area under the curve for detection of any size OV of 0.85 (95% confidence interval 0.78-0.92). At a cut-off of 909 (n = 4 studies) and prevalence rates of 10, 20, 30, 40 and 50% for OV, PSR screening correctly avoided the need for OGD in 70, 62, 55, 47 and 39% of patients, respectively. CONCLUSIONS PSR appears to be the most accurate and validated non-invasive screening test for OV in patients with compensated cirrhosis. At a cut-off of 909, PSR could be clinically useful to avoid OGDs in a significant proportion of patients.
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Affiliation(s)
- Sarmed S. Sami
- NIHR Nottingham Digestive Diseases
Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the
University of Nottingham, Nottingham, United Kingdom
| | - David Harman
- NIHR Nottingham Digestive Diseases
Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the
University of Nottingham, Nottingham, United Kingdom
| | - Krish Ragunath
- NIHR Nottingham Digestive Diseases
Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the
University of Nottingham, Nottingham, United Kingdom
| | - Dankmar Böhning
- Statistical Sciences Research Institute,
University of Southampton, Southampton, United Kingdom
| | - Julie Parkes
- Public Health Sciences & Medical
Statistics, University of Southampton, Southampton, United Kingdom
| | - Indra Neil Guha
- NIHR Nottingham Digestive Diseases
Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the
University of Nottingham, Nottingham, United Kingdom
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Platelet count/prothrombin time ratio as a noninvasive predictor for esophageal varices in Egyptian patients with hepatitis C virus-related liver cirrhosis. EGYPTIAN LIVER JOURNAL 2018. [DOI: 10.1097/01.elx.0000546497.06251.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Noninvasive Methods of Predicting Large Esophageal Varices in Children With Intrahepatic Portal Hypertension. J Pediatr Gastroenterol Nutr 2018; 66:442-446. [PMID: 29176477 DOI: 10.1097/mpg.0000000000001841] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Esophageal variceal bleeding is a severe complication of portal hypertension. The standard diagnostic screening test and therapeutic procedure for esophageal varices (EV) is endoscopy, which is invasive in pediatric patients. This study aimed to evaluate the role of noninvasive parameters as predictors of large varices in children with intrahepatic portal hypertension. METHODS Participants included in this cross-sectional study underwent a screening endoscopy. Variceal size, red marks, and portal gastropathy were assessed and rated. Patients were classified into two groups: Group 1 (G1) with small or no varices and Group 2 (G2) with large varices. The population consisted of 98 children with no history of gastrointestinal (GI) bleeding, with a mean age of 8.9 ± 4.7 years. The main outcome evaluated was the presence of large varices. RESULTS The first endoscopy session revealed the presence of large varices in 32 children. The best noninvasive predictors for large varices were platelets (Area under the ROC Curve [AUROC] 0.67; 95% CI 0.57-0.78), the Clinical Prediction Rule (CPR; AUROC 0.65; 95% CI 0.54-0.76), and risk score (AUROC 0.66; 95% CI 0.56-0.76). The logistic regression model showed that children with a CPR value under 114 were 8.59 times more likely to have large varices. Risk scores higher than -1.2 also increased the likelihood of large varices (OR 6.09; P = 0.014), as did a platelet count/spleen size z score lower than 25 (OR 3.99; P = 0.043). The combination of these three tests showed a high negative predictive value. CONCLUSIONS The CPR, the risk score, and the platelet count/spleen size z score could be helpful in identifying cirrhotic children who may be eligible for endoscopy.
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Platelet Count to Spleen Diameter Ratio for the Diagnosis of Gastroesophageal Varices in Liver Cirrhosis: A Systematic Review and Meta-Analysis. Gastroenterol Res Pract 2017; 2017:7407506. [PMID: 28270848 PMCID: PMC5320338 DOI: 10.1155/2017/7407506] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 11/30/2016] [Indexed: 12/15/2022] Open
Abstract
Platelet count to spleen diameter ratio (PSR) was studied extensively as a noninvasive method of diagnosis for varices. The present study aimed to systematically assess the performance of PSR in the diagnosis of varices. PubMed, EMBASE, and article references were searched. The summary receiver operating characteristic curves (AUSROCs), sensitivities, specificities, positive and negative likelihood ratio, and diagnostic odds ratio were calculated. The heterogeneity, quality, and publication bias of studies were evaluated. Subgroup and sensitivity analyses were performed. A total of 49 papers were included. The AUSROCs of PSR for any varices and high-risk varices were 0.8719 and 0.8132, respectively. The summary sensitivities of PSR for any varices and high-risk varices were 0.84 and 0.78, respectively. The summary specificities of PSR for any varices and high-risk varices were 0.78 and 0.67, respectively. The AUSROC of PSR for any varices at the threshold of 909 was 0.8867. The AUSROC of PSR for any varices in viral liver cirrhosis was 0.8675. The overall quality of studies was moderate. Significant heterogeneity and publication bias existed in the study. In conclusion, PSR can be used to identify varices in liver cirrhosis. PSR had a high sensitivity in viral liver cirrhosis.
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Non-invasive Diagnosis of Oesophageal Varices Using Systemic Haemodynamic Measurements by Finometry: Comparison with Other Non-invasive Predictive Scores. J Clin Exp Hepatol 2016; 6:195-202. [PMID: 27746615 PMCID: PMC5052405 DOI: 10.1016/j.jceh.2016.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 05/08/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS Cirrhosis and portal hypertension are characterised by a hyperdynamic circulation, which is independently associated with variceal size. Non-invasive techniques for measurement of systemic haemodynamics are now available. The aim of the study was to prospectively assess the accuracy of systemic haemodynamics measured non-invasively for the detection of oesophageal varices in cirrhotic patients as compared to other currently available non-invasive methods. METHODS In a study of 29 cirrhotic patients, systemic haemodynamics were studied non-invasively using the Finometer® (mean arterial pressure (MAP), cardiac output (CO)/index, heart rate (HR), peripheral vascular resistance) and portal pressure was assessed by hepatic venous pressure gradient. Sensitivity, specificity, predictive values and area under the receiver operating characteristic (ROC) curves were assessed for predicting presence of varices and large oesophageal varices. Results were compared to child's classification, platelet/spleen ratio and ALT/AST ratios as predictors of the presence of large varices. RESULTS Using finometry large oesophageal varices were correctly predicted in 83% of patients compared to other non-invasive techniques (range 66-76%). CONCLUSIONS Non-invasive assessment of systemic haemodynamics using finometry could aid the identification of patients who do not immediately require variceal surveillance reducing the numbers of endoscopies and ensuring services are provided to those most likely to benefit.
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Key Words
- AAR, AST/ALT ratio
- CI, cardiac index
- CO, cardiac output
- DBP, diastolic blood pressure
- HR, heart rate
- HVPG, hepatic venous pressure gradient
- IQR, interquartile range
- LOV, large oesophageal varices
- LR+, positive likelihood ratio
- LR−, negative likelihood ratio
- MAP, mean arterial pressure
- MELD, model of end stage liver disease
- NIEC, North Italian Endoscopy Club
- NPV, negative predictive value
- PPV, positive predictive value
- PSDR, platelet count-to spleen diameter ratio
- PT, prothrombin time
- PVR, peripheral resistance
- ROC, receiver operating characteristic
- SBP, systolic blood pressure
- SV, stroke volume
- Se, sensitivity
- Sp, specificity
- finometry
- non-invasive predictive scores
- oesophageal varices
- systemic haemodynamics
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Razek AAKA, Massoud SMA, Azziz MRA, El-Bendary MM, Zalata K, Motawea EM. Prediction of esophageal varices in cirrhotic patients with apparent diffusion coefficient of the spleen. ACTA ACUST UNITED AC 2016; 40:1465-9. [PMID: 25732406 DOI: 10.1007/s00261-015-0391-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To predict esophageal varices in cirrhotic patients with apparent diffusion coefficient (ADC) of the spleen and to correlate the ADC with clinical and laboratory biomarkers of esophageal varices. MATERIALS AND METHODS This study was conducted upon 40 patients (28 male, 12 female; age ranged 19-45 years; mean age = 33 years) with biopsy-proven cirrhotic liver. Twenty age- and sex-matched healthy volunteers were included as a control group. Patients with varices (n = 15) and without varices (n = 25) and volunteers underwent echo-planar diffusion-weighted MR imaging of the abdomen with b factors of 0, 400, and 800 s/mm(2). The ADC maps of the abdomen were reconstructed. The ADC values of the spleen were calculated and correlated with the Child score, platelet count, and prothrombin time. RESULTS The mean ADC value of the spleen in cirrhotic patients (1.34 ± 0.05 × 10(-3) mm(2)/s) was significantly different (P = 0.001) from that of volunteers (0.87 ± 0.04 × 10(-3) mm(2)/s). The ADC of the spleen in cirrhotic patients with varices (1.49 ± 0.05 × 10(-3) mm(2)/s) was significantly different (P = 0.001) from that of patients without varices (1.11 ± 0.06 × 10(-3) mm(2)/s). The cut-off ADC value of the spleen used for prediction of cirrhosis and varices was 1.15 and 1.29 × 10(-3) mm(2)/s with areas under the curve were 0.872 and 0.889, respectively. The ADC value of the spleen was correlated with the splenic volume (r = 0.862; P = 0.001), Child score (r = 0.742; P = 0.001), platelet count (r = -0.698; P = 0.01), and prothrombin time (r = 0.684; P = 0.01). CONCLUSION The ADC value of the spleen can predict esophageal varices in cirrhotic patients and is well correlated with the clinical and laboratory biomarkers of esophageal varices.
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11
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Wong GLH, Espinosa WZ, Wong VWS. Personalized management of cirrhosis by non-invasive tests of liver fibrosis. Clin Mol Hepatol 2015; 21:200-11. [PMID: 26523265 PMCID: PMC4612280 DOI: 10.3350/cmh.2015.21.3.200] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/15/2015] [Indexed: 02/06/2023] Open
Abstract
Owing to the high prevalence of various chronic liver diseases, cirrhosis is one of the leading causes of morbidity and mortality worldwide. In recent years, the development of non-invasive tests of fibrosis allows accurate diagnosis of cirrhosis and reduces the need for liver biopsy. In this review, we discuss the application of these non-invasive tests beyond the diagnosis of cirrhosis. In particular, their role in the selection of patients for hepatocellular carcinoma surveillance and varices screening is highlighted.
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Affiliation(s)
- Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong. ; State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | | | - Vicnent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong. ; State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
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Tana MM, Zhao X, Bradshaw A, Moon MS, Page S, Turner T, Rivera E, Kleiner DE, Heller T. Factors associated with the platelet count in patients with chronic hepatitis C. Thromb Res 2015; 135:823-8. [PMID: 25728497 DOI: 10.1016/j.thromres.2015.02.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/05/2015] [Accepted: 02/10/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND There are many potential causes of thrombocytopenia in patients with chronic hepatitis C (CHC). AIMS We sought to determine the association between thrombopoietin (TPO) level, immature platelet fraction (IPF), immunoglobulin G (IgG) level, spleen size, and the platelet count in CHC. METHODS We studied a consecutive sample of patients enrolled in an observational study at a referral-based research center, excluding subjects based on eligibility criteria. TPO, glycocalicin, and von Willebrand Factor (vWF) levels were determined using stored sera. Hepatic fibrosis was assessed via transient elastography (TE) when available, and clinical laboratory values and radiologic data were obtained from the medical record. We performed analyses of the relationships between independent variables and the platelet count. RESULTS On univariate analysis, the following variables were significantly associated with the platelet count: age, alanine aminotransferase (ALT), direct bilirubin, total bilirubin, IPF, international normalized ratio (INR), spleen size, vWF, glycocalicin, fibrosis stage on liver biopsy, and TE (P-values all <0.05). A multivariable model determined that imputed TE score, TPO, IPF, and spleen size were independently associated with the platelet count (P-values all<0.05). CONCLUSIONS The platelet count in CHC is significantly associated with fibrosis, TPO level, IPF, and spleen size. Our findings challenge the proposed mechanism of decreased TPO levels or decreased bone marrow production of platelets as a cause of thrombocytopenia in CHC. Future studies focusing on the effects of fibrosis and splenomegaly on platelets may shed more light on the pathophysiology of thrombocytopenia in patients with CHC.
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Affiliation(s)
- Michele M Tana
- Liver Diseases Branch, Division of Intramural Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 9000 Rockville Pike, Bldg. 10 Rm. 9B16, Bethesda, MD 20892, USA; Division of Gastroenterology, UCSF Liver Center, University of California, San Francisco, USA.
| | - Xiongce Zhao
- Liver Diseases Branch, Division of Intramural Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 9000 Rockville Pike, Bldg. 10 Rm. 9B16, Bethesda, MD 20892, USA
| | - Alyson Bradshaw
- Liver Diseases Branch, Division of Intramural Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 9000 Rockville Pike, Bldg. 10 Rm. 9B16, Bethesda, MD 20892, USA
| | - Mi Sun Moon
- Liver Diseases Branch, Division of Intramural Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 9000 Rockville Pike, Bldg. 10 Rm. 9B16, Bethesda, MD 20892, USA
| | - Sandy Page
- Liver Diseases Branch, Division of Intramural Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 9000 Rockville Pike, Bldg. 10 Rm. 9B16, Bethesda, MD 20892, USA
| | - Tiffany Turner
- Liver Diseases Branch, Division of Intramural Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 9000 Rockville Pike, Bldg. 10 Rm. 9B16, Bethesda, MD 20892, USA
| | - Elenita Rivera
- Liver Diseases Branch, Division of Intramural Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 9000 Rockville Pike, Bldg. 10 Rm. 9B16, Bethesda, MD 20892, USA
| | - David E Kleiner
- National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Bldg. 10 Rm. 9B16, Bethesda, MD 20892, USA
| | - Theo Heller
- Liver Diseases Branch, Division of Intramural Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 9000 Rockville Pike, Bldg. 10 Rm. 9B16, Bethesda, MD 20892, USA
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Giannini EG, Savarino V. Comment to "Platelet count/spleen diameter ratio for non-invasive diagnosis of oesophageal varices: is it useful in compensated cirrhosis?". Dig Liver Dis 2012; 44:965. [PMID: 22717675 DOI: 10.1016/j.dld.2012.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 05/17/2012] [Indexed: 12/11/2022]
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Zhang H, Gao C, Fang L, Zhao HC, Yao SK. Correlation between serum-ascites albumin gradient and degree of esophageal varices in patients with hepatic cirrhosis. Shijie Huaren Xiaohua Zazhi 2012; 20:2608-2612. [DOI: 10.11569/wcjd.v20.i27.2608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the correlation between serum-ascites albumin gradient (SAAG) and the degree of esophageal varices in patients with liver cirrhosis.
METHODS: Cirrhotic patients with ascites were collected and divided into three groups according to the degree of esophageal varices: mild group, moderate group and severe group. One-way ANOVA, correlation analysis and receiver operating characteristic (ROC) curve were used for statistical analysis.
RESULTS: A total of 43 cirrhotic patients were included in our study. One-way ANOVA indicated a significant difference in SAAG among the three groups (F = 26.317, P < 0.001). Spearman correlation analysis suggested a positive correlation between SAAG and esophageal varices (r = 0.759, P < 0. 001). ROC curve analysis indicated that the area under the ROC curve was 0.926, and the best cut-off value for diagnosis of moderate and severe esophageal varices was 20.5 g/L, with a sensitivity of 87.1% and a specificity of 83.3%.
CONCLUSION: SAAG is correlated well with the degree of esophageal varices in cirrhotic patients, and this parameter has appreciable value in diagnosis of moderate and severe esophageal varices.
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