Rabab Fouad, Iman Hamza, Marwa Khairy, Marwa Elsharkawy, Amal Anwar and Mahmoud Abouelkhair
Background and aim: Still research is carried out for imaging and laboratory tools that can replace gastroscopy in esophageal varices prediction. Different non-invasive fibrosis predictors have shown promising results in predicting the presence of varices. In addition, serum sCD163 correlates with hepatic venous pressure
gradient (HVPG). We had investigated different non-invasive tools for predicting the presence, size and/or bleeding risk of esophageal varices against gastroscopy as the gold standard as well as a stratification tool to identify patients who benefit from individualized surveillance or secondary prophylaxis.
Methods: 243 cirrhotic patients were divided into three groups; group I: no varices, group II: small-sized varices, group III: mediumsized, large-sized and any size varices with risky signs. Assessment of sCD163 level, abdominal ultrasound and routine laboratory investigations were carried out. APRI, FIB-4, Lok’s score, Fibroindex, AAR and Platelet/spleen ratio were calculated and patients were monitored for one year. Band ligation was performed for significant varices and number of sessions and obliteration were recorded.
Results: sCD163 levels were higher in patients having large varices (p=0.012), at risk of bleeding (p=0.04) and the bleeding patients (p=0.001). Lower albumin levels and platelets count, higher portal vein and splenic diameters, APRI, FIB4, Lok’s score, Fibroindex, AAR and platelet/spleen ratio were significant in patients with varices. Plt/spleen ratio had the best performance model in predicting varices using multivariate analysis with correct classification of 75.9%.
Conclusion: Non-invasive fibrosis markers, especially the Plt/spleen diameter ratio; can predict the presence of esophageal varices; however, they still lack the specificity and sensitivity that make them replacing the screening endoscopy. Combining sCD163 to these tests may help in predicting bleeding risk. However, further studies are to be carved.
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