Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 28, 2016; 8(24): 1028-1037
Published online Aug 28, 2016. doi: 10.4254/wjh.v8.i24.1028
Diagnostic non-invasive model of large risky esophageal varices in cirrhotic hepatitis C virus patients
Hatem Elalfy, Walid Elsherbiny, Ashraf Abdel Rahman, Dina Elhammady, Shaker Wagih Shaltout, Ayman Z Elsamanoudy, Bassem El Deek
Hatem Elalfy, Walid Elsherbiny, Dina Elhammady, Shaker Wagih Shaltout, Tropical Medicine Department, Mansoura Faculty of Medicine, Mansoura University Hospital, Mansoura 35516, Egypt
Ashraf Abdel Rahman, Diagnostic Radiology Department, Mansoura Faculty of Medicine, Mansoura University Children Hospital, Mansoura 35516, Egypt
Ayman Z Elsamanoudy, Medical Biochemistry and Molecular Biology, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
Bassem El Deek, Department of Community Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
Author contributions: Elalfy H, Elsherbiny W, Abdel Rahman A and Shaltout SW designed the research; Elalfy H, Elsherbiny W and Shaltout SW performed patients selection and clinical evaluation with endoscopy practice; Abdel Rahman A performed and analyzed the CT; Elhammady D and Elalfy H wrote the paper; El Deek B analyzed the data; Elsamanoudy AZ performed and analyzed the laboratory tests.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Faculty of medicine, Mansours University.
Informed consent statement: Written informed consent was signed by the patients for the treatment and sample usage in this study.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Hatem Elalfy, Assistant Professor, Tropical Medicine Department, Mansoura Faculty of Medicine, Mansoura University Hospital, Algomhoria Street, Mansoura 35516, Egypt. elalfy_hatem66@yahoo.com
Telephone: +20-12-24790518 Fax: +20-50-2267563
Received: March 23, 2016
Peer-review started: March 24, 2016
First decision: May 23, 2016
Revised: June 4, 2016
Accepted: July 20, 2016
Article in press: July 22, 2016
Published online: August 28, 2016
Processing time: 154 Days and 21.2 Hours
Abstract
AIM

To build a diagnostic non-invasive model for screening of large varices in cirrhotic hepatitis C virus (HCV) patients.

METHODS

This study was conducted on 124 post-HCV cirrhotic patients presenting to the clinics of the Endemic Medicine Department at Mansoura University Hospital for evaluation before HCV antiviral therapy: 78 were Child A and 46 were Child B (score ≤ 8). Inclusion criteria for patients enrolled in this study was presence of cirrhotic HCV (diagnosed by either biopsy or fulfillment of clinical basis). Exclusion criteria consisted of patients with other etiologies of liver cirrhosis, e.g., hepatitis B virus and patients with high MELD score on transplant list. All patients were subjected to full medical record, full basic investigations, endoscopy, and computed tomography (CT), and then divided into groups with no varices, small varices, or large risky varices. In addition, values of Fibrosis-4 score (FIB-4), aminotransferase-to-platelet ratio index (APRI), and platelet count/splenic diameter ratio (PC/SD) were also calculated.

RESULTS

Detection of large varies is a multi-factorial process, affected by many variables. Choosing binary logistic regression, dependent factors were either large or small varices while independent factors included CT variables such coronary vein diameter, portal vein (PV) diameter, lieno-renal shunt and other laboratory non-invasive variables namely FIB-4, APRI, and platelet count/splenic diameter. Receiver operating characteristic (ROC) curve was plotted to determine the accuracy of non-invasive parameters for predicting the presence of large esophageal varices and the area under the ROC curve for each one of these parameters was obtained. A model was established and the best model for prediction of large risky esophageal varices used both PC/SD and PV diameter (75% accuracy), while the logistic model equation was shown to be (PV diameter × -0.256) plus (PC/SD × -0.006) plus (8.155). Values nearing 2 or more denote large varices.

CONCLUSION

This model equation has 86.9% sensitivity and 57.1% specificity, and would be of clinical applicability with 75% accuracy.

Keywords: Diagnostic model; Large varices; Cirrhotic hepatitis C virus; Computed tomography; Noninvasive variceal diagnosis

Core tip: Hepatitis C virus infection is a major global health problem, with over 14% of the Egyptian population currently infected. End-stage liver disease with cirrhosis is commonly complicated by potentially life-threatening esophageal varices, which require regular screening by endoscopy. However, this invasive procedure is burdened by patient non-compliance and possible complications, thus prompting the search for alternative non-invasive yet accurate means of diagnosis. This study group aimed to assess the use of computed tomography to evaluate and grade variceal size, and to compare its diagnostic value with other non-invasive predictors of portal hypertension, such as platelet count to splenic diameter ratio, aminotransferase-to-platelet ratio index, and Fibrosis-4 score.