Evaluation of Noninvasive Tools for Predicting Esophageal Varices in Patients With Cirrhosis at Tygerberg Hospital, Cape Town.

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY International Journal of Hepatology Pub Date : 2024-09-11 eCollection Date: 2024-01-01 DOI:10.1155/2024/9952610
Lawrence Kwape, Shiraaz Gabriel, Ahmad Abdelsalem, Penelope Rose, Lefika Bathobakae, Dale Peterson, Desiree Moodley, Mohammed Parker, Saadiq Moolla, Arifa Parker, Keatlaretse Siamisang, Christoffel Van Rensburg, Ernst Fredericks
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Abstract

Background: In patients with cirrhosis, esophageal variceal hemorrhage (EVH) is a devastating consequence of portal hypertension (PH). Upper endoscopy is considered the gold standard for the detection and diagnosis of esophageal varices (EVs), despite being invasive and costly. This study was aimed at identifying and evaluating the diagnostic accuracy of noninvasive tools in predicting EVs in patients with compensated cirrhosis. Methods: This cross-sectional study included 50 patients with compensated cirrhosis at the Tygerberg Hospital Gastroenterology Clinic in Cape Town between November 2022 and May 2023. We collected clinical, anthropometric, and laboratory data from patients' physical and electronic charts. All patients underwent an abdominal ultrasound, vibration-controlled transient elastography (VCTE) to assess liver and splenic stiffness, and upper endoscopy. In this comparative study, we evaluated the diagnostic accuracy of different noninvasive tools in detecting EVs in patients with compensated cirrhosis. Results: Of the 50 patients included in the study, 30 (60%) were female and 20 (40%) were male. The patients' age ranged from 18 to 83, with a mean age of 46.6 years. Cirrhosis was mainly due to alcohol use (n = 11, 22%), hepatitis B virus (HBV) infection (n = 11, 22%), and autoimmune hepatitis (n = 10, 20%). The patients included in the study were divided into two subgroups: with (n = 34, 68%) or without (n = 16, 32%) EVs. Statistically significant differences were detected between groups in platelet count (PC), liver stiffness measurement (LSM), spleen stiffness measurement (SSM), portal vein diameter (PVD), bipolar spleen diameter (SBD), aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis-4 index (FIB-4), platelet/bipolar spleen diameter ratio (PSR), liver stiffness-spleen size-platelet ratio (LSPS), liver stiffness-spleen stiffness-platelet ratio score (LS3PS), and spleen stiffness-spleen size-platelet ratio score (SSPS) (p < 0.001). The highest diagnostic precision was observed with SSM (96%), SSPS (96%), LS3PS (94%), LSPS (94%), PSR (94%), and PC (92%). SBD (88%), LSM (86%), APRI (82%), and FIB-4 (82%) had the lowest diagnostic accuracy. Conclusion: SSM and SSPS have the highest diagnostic accuracy for predicting the presence of EVs in patients with compensated cirrhosis. LSPS, LS3PS, and PSR come second at 94%. We recommend SSM and SSPS in institutions with transient elastography equipped with the software necessary to measure splenic stiffness. We introduce and propose LS3PS as a novel composite score for predicting the presence of EVs in patients with compensated cirrhosis. Large-sample-size studies are needed to validate these prediction scores and to allow direct comparison with Baveno VII. These prediction tools can help clinicians avoid unnecessary endoscopic procedures in patients with compensated cirrhosis, especially in developing countries with limited resources such as South Africa.

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评估用于预测开普敦泰格贝格医院肝硬化患者食管静脉曲张的无创工具。
背景:在肝硬化患者中,食管静脉曲张出血(EVH)是门静脉高压症(PH)的一种破坏性后果。上消化道内窥镜被认为是检测和诊断食管静脉曲张(EVs)的金标准,尽管它具有侵入性且费用昂贵。本研究旨在确定和评估无创工具在预测代偿期肝硬化患者食管静脉曲张方面的诊断准确性。研究方法这项横断面研究纳入了 2022 年 11 月至 2023 年 5 月期间在开普敦 Tygerberg 医院消化内科门诊就诊的 50 名代偿期肝硬化患者。我们从患者的体格检查和电子病历中收集了临床、人体测量和实验室数据。所有患者都接受了腹部超声波检查、振动控制瞬态弹性成像(VCTE)以评估肝脏和脾脏的硬度,以及上内镜检查。在这项比较研究中,我们评估了不同无创工具在检测代偿期肝硬化患者 EVs 方面的诊断准确性。研究结果在纳入研究的 50 名患者中,30 名(60%)为女性,20 名(40%)为男性。患者年龄从18岁到83岁不等,平均年龄为46.6岁。肝硬化的主要原因是酗酒(11 人,22%)、乙型肝炎病毒(HBV)感染(11 人,22%)和自身免疫性肝炎(10 人,20%)。参与研究的患者被分为两个亚组:有 EVs(34 人,占 68%)或无 EVs(16 人,占 32%)。在血小板计数(PC)、肝脏硬度测量(LSM)、脾脏硬度测量(SSM)、门静脉直径(PVD)、双极脾脏直径(SBD)、天门冬氨酸氨基转移酶与血小板比值指数(APRI)等指标上,发现组间存在明显统计学差异、纤维化-4 指数(FIB-4)、血小板/双极脾直径比值(PSR)、肝硬度-脾大小-血小板比值(LSPS)、肝硬度-脾硬度-血小板比值评分(LS3PS)和脾硬度-脾大小-血小板比值评分(SSPS)(P < 0.001).诊断精确度最高的是 SSM(96%)、SSPS(96%)、LS3PS(94%)、LSPS(94%)、PSR(94%)和 PC(92%)。SBD(88%)、LSM(86%)、APRI(82%)和 FIB-4(82%)的诊断精确度最低。结论SSM 和 SSPS 预测代偿期肝硬化患者体内存在 EVs 的诊断准确率最高。其次是 LSPS、LS3PS 和 PSR,准确率为 94%。我们建议拥有瞬态弹性成像技术并配备了测量脾脏硬度所需软件的机构采用 SSM 和 SSPS。我们提出并建议将 LS3PS 作为预测代偿期肝硬化患者是否存在 EVs 的新型综合评分。需要进行大样本量的研究来验证这些预测评分,并与 Baveno VII 进行直接比较。这些预测工具可以帮助临床医生避免对代偿期肝硬化患者进行不必要的内镜手术,尤其是在南非等资源有限的发展中国家。
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来源期刊
International Journal of Hepatology
International Journal of Hepatology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
3.80
自引率
0.00%
发文量
11
审稿时长
15 weeks
期刊介绍: International Journal of Hepatology is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies related to the medical, surgical, pathological, biochemical, and physiological aspects of hepatology, as well as the management of disorders affecting the liver, gallbladder, biliary tree, and pancreas.
期刊最新文献
Utilization of Contrast-Enhanced Ultrasound in Diagnosis of Focal Liver Lesions. Anatomical Variations of the Gallbladder and Bile Ducts: An MRI Study. The Role of Gut Microbiota Modification in Nonalcoholic Fatty Liver Disease Treatment Strategies. Evaluation of Noninvasive Tools for Predicting Esophageal Varices in Patients With Cirrhosis at Tygerberg Hospital, Cape Town. Impact of Renal Replacement Therapy on Outcomes of Living Donor Liver Transplantation for Acute Liver Failure: A Cohort Study.
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