Non-invasive Methods For The Diagnosis Of Esophageal Varices With Cirrhosis After Viral Hepatitis

BackgroundPortal hypertensive gastrointestinal bleeding is the main cause of death in those patients with cirrhosis. Esophageal-gastric varices (EGV) and variceal hemorrhage are the main complications of cirrhosis that result from portal hypertension. Some research showed that there were four risk factors for variceal bleeding which included the degree of EGV, red signs on variceal vessel, Child-Pugh classifications, hepatic venous pressure gradient (HVPG)≥12mmHg. A study reported that the mortality of patients with EGV or ascites or variceal bleeding was much more than the rate of patients without these complications. Therefore early diagnosis and treatment of EGV caused by cirrhosis would be vital in order to make treatment plan, avoid bleeding and evaluate prognosis assessment. Upper gastrointestinal endoscopy (UGE) is the gold standard in diagnosis of esophageal varices (EV), but there are many discomforts associated with it, such as nausea, vomiting, aspiration, dyspnea, and arrhythmia. So it is particularly eager to explore a safe and reliable way to guide the diagnosis and management of EV. The study of Giannini et al showed that platelet count/spleen diameter ratio (PC/SD) would be a non-invasive test for diagnosis of EV and the cut off value is909. They thought that when the PC/SD>909, the specificity to exclude diagnosis was100%. But many other researchers didn’t agree with the specificity, they thought that the cut off just was applicable to exclude large EV. At present, there are many scholars performing studies at this sphere. They try to use some blood test and ultrasound test related with cirrhosis. But no acknowledged non-invasive way has been proved to diagnosis EGV. What’s more viral hepatitis is the most common reason lead to cirrhosis in China. Therefore, it is very necessary to explore a non-invasive way to diagnosis EV, guide treatment, evaluate prognosis assessment and avoid those discomforts of UGE.ObjectiveExplore and value the non-invasive way to diagnosis EV caused by cirrhosis after viral hepatitis in order to guide treatment, prevent variceal hemorrhage and evaluate prognosis assessment.MethodsThe clinical data of cases with cirrhosis after viral hepatitis were analyzed retrospectively, who were not suffering from haemophiliacs, portal venous thrombosis, and had not used beta-blocker, endoscopic variceal ligation (EVL) and so on. All of them were divided into two groups by UGE. One was composed of cases without EV or small EV, the other was medium or large EV. Then we collected data of general condition, some routine blood tests and color Doppler ultrasound examination, including age, gender, platelet (PLT), mean platelet volume (MPV), platelet-crit (PCT), platelet distribution width (PDW), AST/ALT(ROAAA), ALT, AST, ALB, TBil, prothrombin time (PT), prothrombin activity (PTA), APRI, portal vein diameter (PVD), spleen vein diameter (SVD), splenic thickness (ST), PLT/ST. SPSS17.0software was used to process case data. T test was used for comparison of quantitative variables with normal distribution, while quantitative variables with skewed distribution were compared by the rank sum test; qualitative variables were analyzed by chi-square test. Regression equation was correlated by multivariate logistic regression, which was made up of parameters which were significantly different in univariate analysis between the groups.Then we drew receiver operating characteristic (ROC) curve to determine the best reference value to diagnosis EV of cirrhosis after viral hepatitis.ResultsAmong the96patients who underwent endoscopy, the parameters had significant difference in univariate logistic regression included PLT, PDW, ALT, AST, and PLT/ST. Through multivariate logistic regression, there was only one parameter, ST in regression equation. The equation was logit P=0.12xST. The area under ROC curve (AUROC) was0.728, and the95%confidence interval (CI) was0.628-0.827. The diagnostic cutoff was the value which had the most specificity and sensitivity. When the cutoff of ST was52.5mm, the sensitivity was53%, the specificity was90%, and Youden index was0.43.ConclusionST had the value to evaluate EV in patients with cirrhosis after viral hepatitis. When ST was more than52.5mm, it would mean that the patient must complicate with medium or large EV. But the clinical value of it should be verified in the further.