Study of Noninvasive Predictors of Portal Hypertension in Liver Cirrhotic Egyptian Patients

Back ground and aim: Hepatitis C Virus (HCV) is considered the most common aetiology of chronic liver disease in Egypt.Portal hypertension is a major complication of liver cirrhosis, and leads to the development of portosystmic shunts. Oesophageal varices are the most important among these shunts. Bleeding from oesophageal varices is the most serious complication of cirrhosis, with a high risk of death. Prevention of variceal bleeding is very important, non-selective beta blockers and prophylactic band ligation decrease the risk of bleeding by 50%. It is recommended to screen all cirrhotic patients by endoscopy, to diagnose who is at risk of bleeding so preventive treatment can be started to them. Repeated endoscopic examinations may lack compliance by many patients, and carries high cost impact and more burden on endoscopic units. For these reasons many non-invasive predictors for the presence and size of varices have been studied. The aim of this study is to evaluate the Child class, spleen size and platelet count as noninvasive predictors of oesophageal varices in Egyptian Cirrhotic patients. Patients and methods: This prospective study included one hundred patients with post hepatitis C virus liver Cirrhosis. All studied patients were subjected to detailed clinical examination and a biochemical workup, including total bilirubin, aspartate aminotransferase, alanine aminotransferase, serum albumin, prothrombin activity, complete blood count and viral markers for hepatitis C and hepatitis B viruses. Child-Pugh score was calculated for all patients using the 5 parameters (ascites, albumin, bilirubin, prothrombin activity and encephalopathy). An upper gastrointestinal endoscopy and abdominal ultrasound were performed for all patients. The maximum spleen bipolar diameter was measured and the values were recorded. Results: All predictors showed statistically significant correlation with the presence and the grade of oesophageal varices (P values <0.001). The spleen size gave the highest accuracy (89%) at a cut-off value of 131.5 (sensitivity 90.24% and specificity 83.33%) followed by the Child class B (accuracy 88%, sensitivity 91.46% and specificity 72.22%) then the platelet count at a cut-of value of 131000/mm(accuracy 84% , sensitivity 84.15% and specificity 83.33%) then lastly came Child class C (accuracy 65% , sensitivity 58.54% and specificity 94.44%). Conclusion: non-invasive parameters based on ultrasonographic measurement and laboratory testing may help the to restrict endoscopy on those who are highly suspected to have oesophageal varices varices in patients with liver cirrhosis. [Serag Esmat and Dalia Omran. Study of Noninvasive Predictors of Portal Hypertension in Liver Cirrhotic Egyptian Patients. Journal of American Science 2011; 7(1):962-968]. (ISSN: 1545-1003). http://www.americanscience.org.