Prediction of large esophageal varices among patients with liver cirrhosis in Sanglah Hospital Denpasar
2014
Objective: Findings of liver cirrhosis are usually accompanied with
screening endoscopy for large esophageal varices (EV) that may benefit
from prophylactic measures. The aim of this study was to identify whether
Model for End-stage Liver Disease (MELD) score, Child-Turcotte-Pugh
(CTP) score, AST to platelet ratio index (APRI), FiB4 index, and laboratory
tests could predict the presence of large EV among patients with liver
cirrhosis in Sanglah Hospital Denpasar. Methods: A total of 90 hospitalized
liver cirrhosis patients from September 2012 until March 2014 were
restrospectively analyzed. Variables used in the analysis included age, sex,
etiology of cirrhosis, CTP classification, MELD score, APRI, FiB4 index, platelet count, serum creatinine, and liver function tests. The presence of
large EV was correlated with those characteristics. Univariate and multiple
regression analysis were used to determine which factors may predict large
EV. Results: Of ninety (90) patients enrolled, 66 were male (73.3%) and
24 were female (26.7%); majority with chronic hepatitis B. Sixty (66.7%)
of the 90 patients were found to have large EV. The distribution of large EV
according to CTP classification was as follows: A, 63.16%; B, 62.8% and
C, 75%. Large EV was independently associated with total bilirubin higher
than 1.9 mg/dL (p = 0.010), INR higher than 1.65 (p = 0.018), and platelet
count lower than 105,500/mm3 (p = 0.02). Platelet count lower than
105,500/mm3 had the highest discriminative value for presence of large EV
(sensitivity = 73.33%; specificity = 73.33%; area under receiver operating
characteristics = 0.783). Conclusions: Large EV were found in 66.7% of
patients with liver cirrhosis who underwent hospitalization. In patients
with liver cirrhosis, the existence of thrombocytopenia may predict large
EV which warrant prophylactic therapy.
Key Word(s): 1. large esophageal varices; 2. liver cirrhosis; 3. platelets
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