Predictive Value Of Serum Prealbumin For Esophageal Varices In Patients With Liver Cirrhosis

Background and objective Esophageal varices is one of the complications of portal hypertension caused by liver cirrhosis,and their secondary esophageal variceal bleeding is a common poor prognostic cause in patients with cirrhosis.In the current clinical work,esophagogastroduodenoscopy(EGD)is often used to screen esophageal varices(EV)in patients with liver cirrhosis.Since EGD is an invasive examination method that is not easily accepted by patients and leads to high screening cost,it is of practical value to explore a non-invasive prediction or screening method with easy popularization,low cost and high repeatability.As a serological indicator of hepatocyte function,serum prealbumin has not been used in the prediction and screening of EV or high-risk EV in patients with liver cirrhosis in previous studies.The main purpose of this study was to explore and evaluate the value of serum prealbumin combined with other serological indexes in the prediction and screening of EV or high-risk EV in patients with liver cirrhosis.Methods The clinical data of patients admitted to the Fifth Affiliated Hospital of Guangzhou Medical University from October 2012 to March 2020 who were diagnosed with liver cirrhosis and had esophagogastroduodenoscopy(EGD)examination were retrospectively analyzed.Taking the results of the EGD examination report as the gold standard for judging the occurrence of EV,patients were divided into EV group,non-EV group/high-risk EV group,non-high-risk EV group.In univariate analysis,the measurement data of normal distribution between the two groups were tested by two independent samples T test,the measurement data of non-normal distribution and grade counting data were compared by Mann-Whitney U test,and the non-grade data(gender)were tested by Fisher exact probability test andχ~2test.Furthermore,binary Logistic regression analysis was used to determine the independent risk factors of EV in patients with liver cirrhosis,and the subjects’working characteristic curve(ROC curve)was drawn to evaluate the predictive efficiency of each index for the occurrence of EV,and the Cut-off value was selected by calculating youden index.Then the prediction or screening model of EV or high risk EV was constructed by establishing Logistic regression model or combining the Cut-off values of different independent risk factors.Results Serum prealbumin level was significantly correlated with the occurrence of EV and high-risk EV in patients with cirrhosis(P<0.05).Low serum prealbumin level and low platelet counts were independent risk factors for the occurrence of high-risk EV in patients with liver cirrhosis.Using platelet count≥85.5×10~9/L and serum prealbumin level≥15.2mg/d L as the screening standard for high-risk esophageal varices,nearly half of the cirrhosis patients with non-high-risk esophageal varices could be exempted from esophagogastroduodenoscopy(47%)by this model and the risk of missed diagnosis of high-risk esophageal varices is less than 5%(4.5%).Low serum albumin level and low platelet count were independent risk factors for the occurrence of esophageal varices in liver cirrhosis patients.The AUROC value of the prediction model for esophageal varices which is a combination of four serological markers:serum prealbumin level,platelet count,serum albumin level and peripheral blood alanineaminotransferase level was 0.886,and when using a Cutoff value of 0.713,the model’s predictive sensitivity for EV was 81.6%,specificity was 85.7%,positive predictive value was 90.9%,and negative predictive value was 72.7%.The liver fibrosis scores were not ideal for predicting the occurrence of high-risk EV,though their predictive ability for the occurrence of EV are good.The combination of liver fibrosis scores and serum prealbumin can improve the prediction ability of fibrosis scores for high-risk esophageal varices and esophageal varices to a certain extent.Conclusions 1.Low serum prealbumin level and low platelet count are independent risk factors for the occurrence of high-risk esophageal varices in liver cirrhosis patients,and serum prealbumin level combined with platelet count could be used to effectively screen patients with high-risk esophageal varices in patients with liver cirrhosis.2.Low serum albumin level and low platelet count are independent risk factors for the occurrence of esophageal varices in liver cirrhosis patients.The prediction model for oesophageal varices which is a combination of four serological markers:serum prealbumin level,platelet count,serum albumin level,and peripheral blood glutamic alanine transaminase level had good predictive ability.3.The liver fibrosis scores are not ideal for predicting the occurrence of high-risk EV,and their predictive ability for the occurrence of EV are good.The combination of liver fibrosis scores and serum prealbumin can improve the prediction ability of fibrosis scores for high-risk esophageal varices and esophageal varices to a certain extent.4.Serum prealbumin has a certain degree of predictive potential for the occurrence of esophageal varices or high-risk esophageal varices in patients with liver cirrhosis.The combination of serum prealbumin and other non-invasive indicators may have certain significance for the prediction and screening of esophageal varices in patients with liver cirrhosis.