Sindh Institute of Urology and Transplantation Karachi, Sindh, Pakistan
Introduction: Guidelines recommend periodic endoscopic surveillance for the detection of esophageal varices. However, its avoided by certain patients due to invasiveness and high cost. Identification of non-invasive methods will allow appropriate patient selection. The aim is therefore, to compare the diagnostic performance of different non-invasive indices in predicting esophageal varices.
Methods: This was a cross-sectional prospective study which was conducted at the Department of Hepatogastroenterology, Sindh institute of Urology and Transplantation from July 2021 to December 2021.All patients recently diagnosed with liver cirrhosis were included in the study. Upper GI endoscopy was performed in each patient for the detection of esophageal varices. Area under ROC was obtained to determine the sensitivity ,specificity, PPV ,NPV and diagnostic accuracy of different non-invasive scores such as CTP score, splenic stiffness, liver stiffness,APRI,FIB-4,Platelet count to splenic diameter ratio,P2/MS,AST/ALT,API,SPRI,ASPRI,LSPS in detection of esophageal varices.
Results: Total number patients included in the study were 91.EV were present in 66(72.5%) patients. AUROC was obtained for all the above mentioned scores and was highest for INR to platelet ratio (INPR) (0.987,95% CI 0.97-1.00),followed by splenic size to platelet ratio(SPRI)(0.98,95% CI 0.95-1.00) ,platelet count to splenic diameter(0.977,95%CI of 0.942-1.00) and sum of age and splenic size to platelet ratio(ASPRI)(0.973, 95% CI 0.947-1.00).AUROC for APRI was 0.885(95%CI 0.818-0.95) , for liver stiffness-splenic diameter and platelet count(LSPS) was 0.858(95%CI 0.662-0.887) while that for FIB-4 was 0.79(0.695-0.888).At an INPR cutoff of ≥1.1,the sensitivity was of 98.48%,specificity of 84%,PPV of 94.2%,NPV of 95.5% with diagnostic accuracy of 94.51% for detection of esophageal varices.
Discussion: Among the studied indices, INR –platelet ratio ≥1.1 is a reliable non-invasive bedside assessment tool for the detection of esophageal varices with an excellent diagnostic accuracy.However,further studies comprising of large sample size are required to validate these indices.
