Analysis of noninvasive predictive indices of esophageal varices in patients with posthepatitic cirrhosis

Objective To investigate the clinical significance of noninvasive predictive indices of esophageal varices ( EV) in patients with posthepatitic cirrhosis. Methods Sixty- four patients with posthepatitic cirrhosis, who were hospitalized in the Affiliated Hospital of Yan'an University from February 2011 to January 2013, were enrolled in this study. All patients underwent gastroscopy to evaluate EV. The diameter of portal vein ( PV) , spleen length ( SL) , spleen thickness ( ST) , and degree of ascites were determined by abdominal ultrasound, and the spleen index ( SI) was calculated. Prothrombin time ( PT) , serum albumin ( Alb) , etc., were measured by laboratory testing. Liver function was assessed by Child- Pugh classification. The correlation between each index and EV or severe EV was analyzed based on area under the receiver operating characteristic curve. For normally distributed data, comparison of means between groups was made by one- way analysis of variance; for non- normally distributed data, comparison between groups was made by Kruskal- Wallis H test; correlation analysis was performed by Kendall's rank correlation test. Results Among the 64 patients, 48 ( 75%) had various degrees of EV, including 14 mild cases, 12 moderate cases, and 22 severe cases. There were significant differences in SI, Model for End- Stage Liver Disease ( MELD) score, MELD- Na score between the patients with EV and those without EV ( P < 0. 05) . PV and SI showed significant differences between the mild cases and severe cases ( P < 0. 05) ; SI showed significant differences between the mild cases and moderate cases and between the moderate cases and severe cases ( P < 0. 05 for both) . Alb showed significant difference only between the patients without EV and severe cases ( P < 0. 01) . No significant difference in PT was found between each two patient groups ( P > 0. 05) . As the severity of EV increases, PV, SI, MELD score, and MELD- Na score tended to increase, Alb showeda downward trend, and PT demonstrated no significant changes. The degree of EV was positively correlated with Child- Pugh score ( t = 0. 483, P < 0. 05) , and there was no correlation between the degrees of ascites and EV ( P > 0. 05) . When SI was higher than 58. 96 cm2, its sensitivity, specificity, positive predictive value, and negative predictive value for EV were 91. 7%, 100. 0%, 100. 0%, and 80. 1%, respectively. When SI was higher than 70. 56 cm2, its sensitivity, specificity, positive predictive value, and negative predictive value for EV were 86. 4%, 90. 5%, 96. 5%, and 68. 9%, respectively. Conclusion There is a certain correlation between degree of EV and Child-Pugh score. PV, Alb, SI, MELD score, and MELD- Na score have predictive values for EV, and SI may be used as a sensitive noninvasive predictive index for EV and severe EV in patients with posthepatitic cirrhosis.