NON-INVASIVE TOOLS TO ASSESS THE RISK OF VARICES-NEEDING-TREATMENT IN CIRRHOSIS SECONDARY TO HCV

Laima Alam; Farrukh Saeed

doi:10.51253/pafmj.v71i1.6352

Authors

Laima Alam Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Farrukh Saeed Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v71i1.6352

Keywords:

Cirrhosis, HCV, Non-invasive biomarkers, Varices, Varices-needing-treatment

Abstract

Objective: To assess the non-invasive biomarkers of fibrosis for predicting varices-needing-treatment in patients with cirrhosis secondary to chronic-hepatitis-C.

Study Design: Cross sectional comparative study.

Place and Duration of Study: Department of Gastroenterology, Pak Emirates Military Hospital Rawalpindi, from Jan 2017 to Dec 2017.

Methodology: A total of 153 patients aged 18-79 with cirrhosis, whether compensated or decompensated, secondary to chronic-hepatitis-C were enrolled. Relevant serum tests were used to calculate non-invasive fibrosis indices and their diagnostic performance to predict the presence of varices and varices-needing-treatment was calculated.

Results: King’s score showed the best performance in detecting varices due to high positive predictive value of 96.4% and positive likelihood ratio of 2.4. Overall, all the non-invasive fibrosis indices exhibited good performance with positive predictive value >85% but none could rule out the presence of varices with adequate reliability due to low negative-predictive-value (<65%). King’s score exhibited relatively higher positive-predictivevalue (70%) and negative predictive value (51.1%) and the lowest negative-likelihood-ratio (0.6) for predicting varices needing treatment. Taken together, none of the non-invasive biomarkers of fibrosis could predict the presence of varices-needing-treatment with adequate accuracy due to low positive-predictive-value (<85%) and
low negative-predictive-value (<65%).

Conclusion: The calculated non-invasive biomarkers of fibrosis and their optimum cutoff values showed modest accuracy for predicting varices and varices-needing-treatment. These indices may be used as first-line screening method for segregation of clinically significant portal hypertension and high risk esophageal varices-needingtreatment but may not be able to replace the gold standards like Fibroscan liver and Hepatic Venous Pressure Gradient measurements.