Study of non-invasive parameter for detecting esophageal varices in patients of Chronic Liver Disease with special focus on Liver Stiffness Score and aspartate transaminase to platelets ratio index (APRI)
Dr. Shishirendu S Parihar, Dr. K Deopujari, Dr. Shailendra K Jain
Background: Several investigators have devised non-invasive predictors for presence of esophageal varices (EV) in chronic liver disease (CLD) patients, thus avoiding unnecessary endoscopic screening. Liver stiffness and aspartate transaminase to platelets ratio index (APRI) measurements is good, but still limited tool to noninvasively assess complications and prognosis in patients with advanced liver disease. Aims and Objective: To evaluate the relation between liver stiffness score and APRI measurement with the presence of EV in patient of portal hypertension in CLD. Materials and Methods: Hundred and ten compensated CLD patients were studied at Gandhi Medical College and associated Hamidiya Hospital, Bhopal from August 2016 to January 2018. All the patients underwent a fibroscan examination and upper gastrointestinal endoscopy not more than 3 months apart. All patients were grouped based on Varies grades as Grade I (Small straight esophageal varices), Grade II (Enlarged tortuous EV <1/3 of Lumen), Grade III (Large coil shaped EV >1/3 of Lumen) and Grade IV (Cherry red spots with Impending Bleed or active Bleed). Liver stiffness score and APRI were evaluated for all the patients. Results: Male preponderance (85.3%) was observed with mean of study cohort being 45.55± 12.89 years. Maximum patients had hepatitis B related CLD (43.2%) and belong to child pugh class B (68.2%). Splenomegaly (52.33%) was the most common USG finings. Maximum patients had Grade 3 (36.8%) followed by Grade 4 (28.4%) varices. Patients who had higher varices grading (3-4), more patients had APRI >1.5 (p=0.612). Liver stiffness was positively correlated with the varices grading (r=0.524, p<0.001), similarly APRI was positively correlated (r=529, p=0.012) with liver stiffness. Conclusion: Present study has found asignificant association between fibroscan score, APRI and severity of varices. That means fibroscan score and APRI are important tool for predicting the presence of varices.