Tarannum Suha, Ilyas Taneem, Tarannum Shaik Sumaiya, Sultana Noorin, Saniya Md Nuzhath, Mynampati Amulya Madhulika, Nayak Kukunoor Akshatha, Gogikar Sowmya, Kumar Ramesh
Internal Medicine, Osmania Medical College, Hyderabad, IND.
Medicine, Osmania Medical College, Hyderabad, IND.
Cureus. 2024 Nov 15;16(11):e73768. doi: 10.7759/cureus.73768. eCollection 2024 Nov.
Background Esophageal varices (EVs) develop as a complication of chronic liver disease and, when left unaddressed, can lead to variceal hemorrhage manifesting as severe hematemesis and occasionally, melena. Due to its frequent negative associations, early diagnosis and the implementation of non-selective beta blocker primary prophylaxis are imperative. Although upper gastrointestinal endoscopy has historically been used to image and identify EVs, patients frequently find this intrusive treatment to be uncomfortable and burdensome. It can also be expensive and challenging for patients who live in remote places and healthcare deserts, where access to healthcare is limited. Therefore, it is crucial to identify non-invasive markers for the prediction of variceal bleeding and EVs in individuals with chronic liver disease. Methodology A cross-sectional observational study was done at Osmania General Hospital, a tertiary healthcare center in Hyderabad, India. The study sample consisted of patients with chronic liver disease who underwent upper gastrointestinal endoscopy during the study period in keeping with the inclusion and exclusion criteria. In a sample of 103 patients, the mean age was 10.72±45.55 years, with 22 females (21.4%) and 81 males (78.6%). The majority (85, 82.5%) had alcoholic chronic liver disease, while 14 (13.6%) had other etiologies, and four (3.9%) had infectious causes. Data were collected to calculate the Child-Pugh score, AST to platelet ratio index (APRI), model for end-stage liver disease (MELD) score, and fibrosis-4 (FIB-4) index. The patients were observed and followed up for a duration of three months. The data were evaluated using chi-squared tests and independent t-tests, chosen according to their relevance, to assess the utility of these scores as non-endoscopic predictors of EVs and esophageal variceal bleeding (EVB). Results The results indicated that only the FIB-4 index was found to be a significant predictor of Grade 2 or higher grades of EV according to the Pacquet classification. The FIB-4 index was significantly higher in the Grade 2 or higher EV group (p = 0.029) with t(101) = 1.98. Conclusion Thus, the study demonstrates that ≥ Grade 2 EV on upper gastrointestinal endoscopy can be predicted using the FIB-4 index. Even though our study shows that the FIB-4 index is a useful noninvasive predictor of EV, large-scale studies with bigger sample sizes and longer follow-up times are necessary to ensure accurate clinical application.
背景 食管静脉曲张（EVs）是慢性肝病的一种并发症，若不加以处理，可导致静脉曲张破裂出血，表现为严重呕血，偶尔也会出现黑便。由于其常常伴有不良后果，早期诊断并实施非选择性β受体阻滞剂一级预防势在必行。尽管上消化道内镜检查一直以来都用于成像和识别食管静脉曲张，但患者常常觉得这种侵入性检查令人不适且负担沉重。对于居住在偏远地区和医疗资源匮乏地区、获得医疗服务受限的患者来说，该项检查还可能费用高昂且颇具挑战性。因此，识别慢性肝病患者中预测静脉曲张破裂出血和食管静脉曲张的非侵入性标志物至关重要。
方法 在印度海得拉巴的一家三级医疗中心奥斯曼尼亚综合医院开展了一项横断面观察性研究。研究样本包括在研究期间符合纳入和排除标准并接受上消化道内镜检查的慢性肝病患者。在103例患者样本中，平均年龄为10.72±45.55岁，其中女性22例（21.4%），男性81例（78.6%）。大多数患者（85例，82.5%）患有酒精性慢性肝病，14例（13.6%）有其他病因，4例（3.9%）有感染性病因。收集数据以计算Child-Pugh评分、谷草转氨酶与血小板比值指数（APRI）、终末期肝病模型（MELD）评分和纤维化-4（FIB-4）指数。对患者进行了为期三个月的观察和随访。根据数据的相关性，使用卡方检验和独立t检验对数据进行评估，以评估这些评分作为食管静脉曲张和食管静脉曲张破裂出血（EVB）非内镜预测指标的效用。
结果 结果表明，根据帕克分类法，仅FIB-4指数被发现是2级或更高等级食管静脉曲张的显著预测指标。2级或更高等级食管静脉曲张组的FIB-4指数显著更高（p = 0.029）,t(101) = 1.98。
结论 因此，该研究表明，使用FIB-指数可以预测上消化道内镜检查中≥2级的食管静脉曲张。尽管我们的研究表明FIB-4指数是食管静脉曲张有用的非侵入性预测指标，但仍需要进行更大样本量和更长随访时间的大规模研究，以确保其在临床中的准确应用。
