Kwape Lawrence, Gabriel Shiraaz, Abdelsalem Ahmad, Rose Penelope, Bathobakae Lefika, Peterson Dale, Moodley Desiree, Parker Mohammed, Moolla Saadiq, Parker Arifa, Siamisang Keatlaretse, Van Rensburg Christoffel, Fredericks Ernst
Division of Gastroenterology and Hepatology Department of Medicine Faculty of Medicine and Health Sciences Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
Department of Paediatrics and Child Health Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
Int J Hepatol. 2024 Sep 11;2024:9952610. doi: 10.1155/2024/9952610. eCollection 2024.
In patients with cirrhosis, esophageal variceal hemorrhage (EVH) is a devastating consequence of portal hypertension (PH). Upper endoscopy is considered the gold standard for the detection and diagnosis of esophageal varices (EVs), despite being invasive and costly. This study was aimed at identifying and evaluating the diagnostic accuracy of noninvasive tools in predicting EVs in patients with compensated cirrhosis. This cross-sectional study included 50 patients with compensated cirrhosis at the Tygerberg Hospital Gastroenterology Clinic in Cape Town between November 2022 and May 2023. We collected clinical, anthropometric, and laboratory data from patients' physical and electronic charts. All patients underwent an abdominal ultrasound, vibration-controlled transient elastography (VCTE) to assess liver and splenic stiffness, and upper endoscopy. In this comparative study, we evaluated the diagnostic accuracy of different noninvasive tools in detecting EVs in patients with compensated cirrhosis. Of the 50 patients included in the study, 30 (60%) were female and 20 (40%) were male. The patients' age ranged from 18 to 83, with a mean age of 46.6 years. Cirrhosis was mainly due to alcohol use ( = 11, 22%), hepatitis B virus (HBV) infection ( = 11, 22%), and autoimmune hepatitis ( = 10, 20%). The patients included in the study were divided into two subgroups: with ( = 34, 68%) or without ( = 16, 32%) EVs. Statistically significant differences were detected between groups in platelet count (PC), liver stiffness measurement (LSM), spleen stiffness measurement (SSM), portal vein diameter (PVD), bipolar spleen diameter (SBD), aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis-4 index (FIB-4), platelet/bipolar spleen diameter ratio (PSR), liver stiffness-spleen size-platelet ratio (LSPS), liver stiffness-spleen stiffness-platelet ratio score (LSPS), and spleen stiffness-spleen size-platelet ratio score (SSPS) ( < 0.001). The highest diagnostic precision was observed with SSM (96%), SSPS (96%), LSPS (94%), LSPS (94%), PSR (94%), and PC (92%). SBD (88%), LSM (86%), APRI (82%), and FIB-4 (82%) had the lowest diagnostic accuracy. : SSM and SSPS have the highest diagnostic accuracy for predicting the presence of EVs in patients with compensated cirrhosis. LSPS, LSPS, and PSR come second at 94%. We recommend SSM and SSPS in institutions with transient elastography equipped with the software necessary to measure splenic stiffness. We introduce and propose LSPS as a novel composite score for predicting the presence of EVs in patients with compensated cirrhosis. Large-sample-size studies are needed to validate these prediction scores and to allow direct comparison with Baveno VII. These prediction tools can help clinicians avoid unnecessary endoscopic procedures in patients with compensated cirrhosis, especially in developing countries with limited resources such as South Africa.
在肝硬化患者中，食管静脉曲张出血（EVH）是门静脉高压（PH）的一个严重后果。尽管上消化道内镜检查具有侵入性且成本高昂，但它仍被视为检测和诊断食管静脉曲张（EVs）的金标准。本研究旨在识别和评估非侵入性工具预测代偿期肝硬化患者食管静脉曲张的诊断准确性。这项横断面研究纳入了2022年11月至2023年5月期间在开普敦泰格伯格医院胃肠病诊所就诊的50例代偿期肝硬化患者。我们从患者的纸质和电子病历中收集了临床、人体测量和实验室数据。所有患者均接受了腹部超声、振动控制瞬时弹性成像（VCTE）以评估肝脏和脾脏硬度，以及上消化道内镜检查。在这项比较研究中，我们评估了不同非侵入性工具检测代偿期肝硬化患者食管静脉曲张的诊断准确性。研究纳入的50例患者中，30例（60%）为女性，20例（40%）为男性。患者年龄在18至83岁之间，平均年龄为46.6岁。肝硬化主要由酒精使用（n = 11，22%）、乙型肝炎病毒（HBV）感染（n = 11，22%）和自身免疫性肝炎（n = 10，20%）引起。研究纳入的患者分为两个亚组：有食管静脉曲张（n = 34，68%）或无食管静脉曲张（n = 16，32%）。两组在血小板计数（PC）、肝脏硬度测量（LSM）、脾脏硬度测量（SSM）、门静脉直径（PVD）、脾脏双极直径（SBD）、天冬氨酸转氨酶与血小板比值指数（APRI）、纤维化-4指数（FIB-4）、血小板/脾脏双极直径比值（PSR）、肝脏硬度-脾脏大小-血小板比值（LSPS）、肝脏硬度-脾脏硬度-血小板比值评分（LSPS）和脾脏硬度-脾脏大小-血小板比值评分（SSPS）方面存在统计学显著差异（P < 0.001）。观察到SSM（96%）、SSPS（96%）、LSPS（94%）、LSPS（94%）、PSR（94%）和PC（92%）的诊断精度最高。SBD（88%）、LSM（86%）、APRI（82%）和FIB-4（82%）的诊断准确性最低。结论：SSM和SSPS在预测代偿期肝硬化患者食管静脉曲张的存在方面具有最高的诊断准确性。LSPS、LSPS和PSR以94%并列第二。我们建议在配备有测量脾脏硬度所需软件的瞬时弹性成像设备的机构中使用SSM和SSPS。我们引入并提出LSPS作为一种新型综合评分，用于预测代偿期肝硬化患者食管静脉曲张的存在。需要进行大样本量研究来验证这些预测评分，并与巴韦诺VII进行直接比较。这些预测工具可以帮助临床医生避免对代偿期肝硬化患者进行不必要的内镜检查，尤其是在南非等资源有限的发展中国家。
