Noninvasive predictors of esophageal varices in patients with hepatosplenic schistosomiasis mansoni

Mateus Jorge Nardelli; Zulane da Silva Tavares Veiga; Luciana Costa Faria; Gustavo Henrique Santos Pereira; Catherine Ferreira da Silva; Fernanda Aziz Barbosa; Flávia Ferreira Fernandes; Renata de Mello Perez; Cristiane Alves Villela-Nogueira; Claudia Alves Couto

doi:10.1016/j.actatropica.2021.106283

Noninvasive predictors of esophageal varices in patients with hepatosplenic schistosomiasis mansoni

Acta Trop. 2022 Feb:226:106283. doi: 10.1016/j.actatropica.2021.106283. Epub 2021 Dec 14.

Affiliations

¹ Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
² Setor de Gastroenterologia e Hepatologia, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil.
³ Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Instituto Alfa de Gastroenterologia, Hospital das Clínicas da Universidade Federal de Minas Gerais, Brazil.
⁴ Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Departmento de Gastroenterologia, Universidade Estadual do Rio de Janeiro, Brazil; Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, Brazil.
⁵ Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
⁶ Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Instituto Alfa de Gastroenterologia, Hospital das Clínicas da Universidade Federal de Minas Gerais, Brazil. Electronic address: clalcouto@gmail.com.

PMID: 34919950
DOI: 10.1016/j.actatropica.2021.106283

Abstract

Background: No previous study have evaluated transient elastography for predicting esophageal varices in hepatosplenic schistosomiasis.

Aim: To investigate noninvasive methods of predicting esophageal varices in patients with hepatosplenic schistosomiasis mansoni.

Methods: Cross-sectional multicentric study included 51 patients with hepatosplenic schistosomiasis. Patients underwent ultrasonography-dopplerfluxometry, upper endoscopy, complete blood cell count and transient elastography (Fibroscan®) for liver and spleen stiffness measurement (LSM and SSM). Noninvasive scores previously established for cirrhotic population were studied: platelet count to spleen diameter ratio (PSR), LSM-spleen diameter to platelet ratio score (LSPS) and varices risk score (VRS). We proposed a version of LSPS and VRS by replacing LSM with SSM and named them SSPS and modified-VRS, respectively.

Results: Esophageal varices were detected in 42 (82.4%) subjects. Individuals with varices presented higher SSM (73.5 vs 36.3 Kpa, p = 0.001), splenic vein diameter (10.8 vs 8.0 mm, p = 0.017), SSPS (18.7 vs 6.7, p = 0.003) and modified-VRS (4.0 vs 1.4, p = 0.013), besides lower PSR (332 vs 542, p = 0.038), than those without varices. SSPS was independently associated with varices presence (OR=1.19, 95%CI 1.03-1.37, p = 0.020) after multivariate analysis. In a model excluding noninvasive scores, SSM was independently associated with varices diagnosis (OR=1.09, 95%CI 1.03-1.16, p = 0.004). AUROC was 0.856 (95%CI 0.752-0.961, p = 0.001) for SSM and 0.816 (95%CI 0.699-0.932, p = 0.003) for SSPS (p = 0.551).

Conclusions: Spleen-related variables were predictors of esophageal varices: SSM, splenic vein diameter, SSPS, modified-VRS and PSR. Multivariate models indicated that SSM and SSPS are useful tools for predicting varices in non-cirrhotic portal hypertension by hepatosplenic schistosomiasis and may be used in clinical practice.

Keywords: Elastography; Esophageal varices; Hepatosplenic schistosomiasis; Noninvasive methods; Schistosomiasis.

Publication types

Multicenter Study

MeSH terms

Cross-Sectional Studies
Elasticity Imaging Techniques*
Esophageal and Gastric Varices* / etiology
Humans
Liver Cirrhosis / complications
Predictive Value of Tests
Schistosomiasis mansoni* / complications
Schistosomiasis*