INTRODUCTION: Esophageal variceal hemorrhage (EVH) is a severe complication of liver cirrhosis with a high mortality rate. Esophagogastroduodenoscopy (EGD) screening to detect esophageal varices (EV) is currently recommended for all newly diagnosed cirrhotic patients. However, many patients who undergo EGD do not have varices, especially in compensated cirrhotic patients. Furthermore, EGD is an expensive and invasive procedure. The aim of the study is to identify a non-invasive and low-cost scoring system that could predict the presence of moderate–large EV in compensated cirrhotic patients. METHODS: A cross-sectional study was conducted in newly diagnosed patients with non-Child-Pugh (CP) C liver cirrhosis, without a history of variceal bleeding. Demographic, clinical, biochemical, and ultrasonographic parameters will be recorded. Presence and degree of esophageal varices will be determined during EGD. In order to identify independent predictors for the presence of esophageal varices, univariate and multivariate logistic regression will be analyzed. RESULTS: EV was found in 47 from 80 patients (58.8%) that were enrolled in this study. Of 47 patients, moderate-large varices was detected in 20/34 (58.8%) and 12/13 (92.3%) patients with CP-A and CP-B class, respectively. In univariate analysis, low platelet count (≤100 000/μL), increased bipolar spleen diameter (≥135 mm), and platelet count/bipolar spleen diameter ratio ≤ 847 were associated with the presence of moderate-large EV. Only platelet count/bipolar spleen diameter ratio was associated in multivariate analysis. The AUC, sensitivity and specificity of platelet count/bipolar spleen diameter ratio ≤ 847 is 0.77, 90.6% and 58.3%, respectively. CONCLUSION: Low platelet count is commonly found in liver cirrhotic patients and easily obtained in resource-limited setting. The enlarged spleen is often observed in patients with liver cirrhosis and associated with a higher risk of complications. The ratio of low platelet count/spleen bipolar diameter has been used to predict the presence of EV in cirrhotic patients, however, the previous studies included the patients with compensated and decompensated cirrhosis. For the implementation in daily clinical practice with resource-limited setting, a patient with compensated liver cirrhosis and platelet count/bipolar spleen diameter ratio ≤ 847 is highly recommended to undergo EGD screening procedure.

AbstrakGenotipe virus hepatitis B (VHB) mempunyai hubungan yang erat dengan prognosis dan terapinya serta diperlukan untuk studi epidemiologi. Pemeriksaan ini hanya bisa dikerjakan di kota-kota besar saja karena kesulitan pengiriman sampel akibat masalah geografis maupun fasilitas. Tujuan penelitian ini adalah untuk mengetahui apakah genotipe VHB dapat ditentukan dari serum kering pada kertas saring dan membandingkan hasil tersebut dengan serum yang diambil langsung dari pasien hepatitis B kronik (HBK) dan hepatoma. Dua puluh tiga sampel dapat diambil dari pasien HBK dan konsentrasi DNA VHB di tentukan dengan Cobas Amplicor HBM (Roche Diagnostics GmBH, Germany) kemudian diteteskan pada kertas saring (3 x 1 cm). Setelah dikeringkan dalam kantong plastik, diletakkan dalam amplop tertutup dan disimpan selama 1 minggu dalam suhu kamar (27 -33 o C). Ekstraksi DNA dilakukan dari kertas saring tersebut setelah diinkubasi dan penentuan genotipe VHB dilakukan dengan PCR menggunakan primer-primer spesifik. Untuk perbandingan, telah didapatkan 20 sampel pasien HBK-HBe (+) dan 29 sampel pasien hepatoma yang tidak dikeringkan. Genotipe VHB dapat dideteksi pada 18/23 (78,2%) serum kering pada kertas saring sedangkan pada serum yang tidak dikeringkan, dari pasien HBK-HBe(+) 20/20 (100%) sampel terdeteksi dan dari pasien hepatoma 24/29 (82,7%) sampel. Proporsi genotipe yang terdeteksi sesuai dengan proporsi genotipe yang pernah dilaporkan di Indonesia. Kesimpulan penelitian ini adalah genotipe VHB dapat dideteksi dari serum kering pada kertas saring yang disimpan selama 1 minggu. (Med J Indones 2005; 14: 215-9)Abstract HBV genotype has a close association with prognosis and therapy as well as for epidemiology study. However, this examination can be done only in large cities that are not practical to send serum sample due to geographical burden and facilities. The aim of this study is to know whether HBV genotype can be determined from dried and stored serum on filter paper and compare the result with sera drawn directly from chronic hepatitis B (CHB) and hepatoma patients. Twenty-three serum samples were obtained from CHB patients. HBV DNA were quantitatively determined with Cobas Amplicor HBM (Roche Diagnostics GmBH, Germany) and dropped on to 3 x 1 cm filter papers. After allowed to dry in a plastic clip, it were put in a closed envelope then stored for 1 week in room condition (27 -33 o C). DNA extraction were done from the filter papers after a short incubation period and HBV genotypes were determined with PCR and specific primers. For comparison, samples and 29 hepatoma samples were drawn directly and not dried. HBV genotype were detected in 18/23 (78.2%) from dried serum samples on filter paper while in sera that were not stored, from CHB-HBe(+) samples, 20/20 (100%) could be determined while from hepatoma patients, 24/29 (82.7%) samples. The proportion of genotype were in line with other reported HBV genotype examination for Indonesia. It is concluded that detection of HBV genotype can be done from dried serum in filter p...

Background Liver cirrhosis is the final stage of chronic liver disease. Complications due to progression of liver disease may deteriorate the liver function and worsen prognosis. Previous studies have shown that patients with liver cirrhosis are at increased risk of death within 90-day after hospitalization. It is necessary to identify patients who are at higher risk of early mortality. This study aims to develop a scoring system to predict the 90-day mortality among hospitalized patients with liver cirrhosis that could be used for modification of treatment plan according to the scores that have been obtained. By using this scoring system, crucial care of plans can be taken to reduce the risk of mortality. Method This prospective cohort study was conducted on hospitalized cirrhotic patients at Cipto Mangunkusumo National General Hospital, Jakarta. Demographic, clinical, and laboratory data were recorded. Patients were monitored for up to 90-day after hospitalization to determine their condition. Cox regression analysis was performed to obtain predictor factors contributing to mortality in liver cirrhosis patients. The scoring system that resulted from this study categorized patients into low, moderate, and high-risk categories based on their predicted mortality rates. The sensitivity and specificity of the scoring system were evaluated using the AUC (area under the curve) metric. Result The study revealed that liver cirrhosis patients who were hospitalized had a 90-day mortality rate of 42.2%, with contributing factors including Child-Pugh, MELD, and leukocyte levels. The combination of these variables had a good discriminative value with an AUC of 0.921 (95% CI: 0.876–0.967). The scoring system resulted in three risk categories: low risk (score of 0–3) with a 4.1-18.4% probability of death, moderate risk (score of 5–6) with a 40.5-54.2% probability of death, and high risk (score of 8–11) with a 78.1-94.9% probability of death. Conclusion The scoring system has shown great accuracy in predicting 90-day mortality in hospitalized cirrhosis patients, making it a valuable tool for identifying the necessary care and interventions needed for these patients upon admission.