Predicting the presence of high-risk oesophageal varices using noninvasive parameters in Egyptian cirrhotic patients

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Abstract

Background

Portal hypertension commonly accompanies liver cirrhosis. Bleeding because of oesophageal varices (OV) is one of the most dreaded complications of cirrhosis because of its high mortality rate. Endoscopy is recommended for the screening of OV.

Aim of the work

We aimed to assess the value of a model for end-stage liver disease (MELD) and MELD-Na scores, platelet count, alanine aminotransferase, aspartate aminotransferase and spleen size as predictors of OV.

Patients and methods

A total of 100 patients with established liver cirrhosis (80 men, 20 women) were enrolled in the study. All patients were subjected to a full clinical assessment and routine laboratory investigations. Child–Turcotte–Pugh, MELD and MELD-Na scores were calculated for each patient. Upper gastrointestinal endoscopy was performed for all patients.

Results

The means of both MELD and MELD-Na were significantly higher among patients with OV. MELD at least 11.5 and MELD-Na at least 14.5 were both sensitive and specific for the presence of OV. Also, the MELD score showed increasing values with increasing grades of OV (P<0.01). Multivariate regression analysis identified the following two predictors of the presence of OV: MELD score at least 11.5 and platelet count up to 142.5 (×1000/mm3).

Conclusion

MELD, MELD-Na, spleen size and low platelet count can be used independently as predictors of OV; also, MELD can predict high-risk varices. However, it cannot completely replace the need for endoscopy because of its low specificity and sensitivity.

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