Accuracy of non-invasive diagnosis of esophageal varices among cirrhotic patients in a low-income setting

Haile Tesfaye Gebregziabiher; Workagegnehu Hailu; Zenahebezu Abay; Segenet Bizuneh; Meiraf Daniel Meshesha

doi:10.1016/j.heliyon.2023.e23229

Accuracy of non-invasive diagnosis of esophageal varices among cirrhotic patients in a low-income setting

Heliyon. 2023 Dec 3;9(12):e23229. doi: 10.1016/j.heliyon.2023.e23229. eCollection 2023 Dec.

Authors

Haile Tesfaye Gebregziabiher¹, Workagegnehu Hailu², Zenahebezu Abay², Segenet Bizuneh², Meiraf Daniel Meshesha¹

Affiliations

¹ Department of Internal Medicine, Dilla University, Dilla, Ethiopia.
² Department of Internal Medicine, University of Gondar, Gondar, Ethiopia.

Abstract

Cirrhosis is a chronic liver disease that is frequently complicated by increased portal venous pressure and the formation of EV. The most common clinical manifestation of portal hypertension is esophageal varices, and ruptured varices are the most fatal complication of portal hypertension. The diagnosis and follow-up of esophageal varices is done by Esophagogastroduodenoscopy, but in most developing countries, the follow-up of cirrhotic patients by gastrointestinal endoscopy remains a challenge.

Objective: Assessment of diagnostic accuracy of noninvasive tests as predictors of esophageal varices among cirrhotic patients at University of Gondar comprehensive Hospital.

Method: Institution based cross-sectional study was conducted among cirrhotic patients from March 2022-October 2022. All study participants underwent screening for Esophageal Varices, Spleen Diameter, Platelet count and Platelet count/spleen diameter ratio. Data were analyzed using SPSS version 26. ROC curves were plotted for Spleen Diameter, Platelet count and Platelet count/spleen diameter ratio with specific cutoffs determined. Diagnostic performance was assessed using ROC curve. The diagnostic thresholds were specified with their sensitivity, specificity, positive predictive value, negative predictive value positive and negative likelihood ratios.

Result: A total of 206 patients were included. The mean age was 41.84 year and SD of (41.84 ± 12.398). About 79.4 % percent were males. Endoscopy confirmed esophageal varices were present in 176(85.4 %) cases. Sixty-seven percent of cases had decompensated cirrhosis (Child-Pugh class B&C). The platelet count to spleen diameter ratio less than 818 had a PPV of 94.7 % (AUROC = 0.835), while spleen diameter greater than 145 mm had 93.7 % PPV (AUROC = 0.783). At a platelet count cutoff <121,000/mm3, the PPV was 95.1 % (AUROC = 0.818).

Conclusion: In this study, platelet count, spleen diameter, and PC/SD all performed well for EV diagnostics, with PC/SD outperforming the others. This finding supports the use of these noninvasive indicators for the diagnosis and implementation of prophylactic treatment foe esophageal varices in health institutions where gastrointestinal endoscopy is unavailable.

Keywords: Cirrhosis; Esophageal varices; Platelets count; Spleen diameter.