Non-Invasive Panel for Prediction of Large Esophageal Varices in Patients with HCV-Related Cirrhosis after DAAS Therapy

Authors : Mohamed Elsayed Abdelaal; Amr Ragab Shalaby; Mahmoud Allam; Hazem Omar; Elsayeb Shaaban Tharwa; Hassan Elsayed Zaghla

Volume/Issue : Volume 8 - 2023, Issue 9 - September

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Aim: This work aim to study sonographic and laboratory parameters as diagnostic non-invasive Indices for prediction and screening of large varices in liver cirrhotic patients post hepatitis C virus after Direct Acting Antiviral Drugs (DAAS).Introduction: All cirrhotic patients should be screened for esophageal varices (EV) via endoscopy, as recommended by the guidelines. However, repeated endoscopy is not well accepted by patients and is a costly procedure that places a heavy burden on the endoscopic unit. Therefore, noninvasive predictors of EVs and size discrimination for EVs are of particular importance.After dividing into three arms: arm 1 with Non-EV, arm 2 grad 1&2 EV (Small Vriceal arm), and arm 3 grade 3 &4 EV (Large Variceal arm). Medical history, physical examination, Standard laboratory tests, Abdominal ultrasound, and Sonographic parameters such as portal vein velocity (PVV). Splenic Index (SI) Splenoportal Index (SPI), platelet count/spleen diameter ratio (PCSDR) and upper gastrointestinal endoscopy were performed for all participants.Results: The Noninvasive sonographic and laboratory parameters for prediction of the presence of EVs have demonstrated that low platelet count/spleen diameter ratio (PC/SD) was found to be the most accurate parameter at cut-off (CO) ≤ 1121.43 cu/mm, then SPI at CO >3.98 cm /sec then FIB4 at CO > 2.68 then APRI at CO > 0.6 then PVV at CO ≤ 22.2 cm/sec then SI at CO > 89.7 and lastly Child’s-Pugh’s score at CO >6 respectively.The Noninvasive sonographic and laboratory parameters for discrimination of the size of EVs showed that high SPI was found to be the most accurate parameter at CO less than >7.75 cm/sec Then low PC/SD at CO ≤ 514.08 cu/mm then APRI at CO > 1.4 then FIB4 at CO > 7,6 then SI with AUC 0.821 at CO > 122.4 then low PVV at CO < 15 and lastly Child’s –Pugh’s score at CO> 6 respectively.Conclusions: The sonographic and laboratory indices are non- invasive parameters for the prediction of EV & discrimination of its size. And to determine when Upper Endoscopy is done for liver cirrhotic patients post HCV after DAAS

Keywords : Liver Cirrhotic Patients Post C after DAAS, Esophageal Varices (EV), Portal Vein Velocity (PVV). Splenic Index (SI) Splenoportal Index (SPI), Platelet Count/Spleen Diameter Ratio (PC/SD), FIB4, APRI,Child– Pugh Score, Upper Endoscopy (UE).


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