No abstract

Background: Esophageal varices (EVs) are atypically dilated submucosal veins, which occurs consequently to portal hypertension. Liver stiffness measurement (LSM), obtained by transient elastography (Fibroscan), strongly correlates with portal hypertension. Aim: Is to predict the presence and grading of esophageal varices in Egyptian patients with liver cirrhosis using Fibroscan and other noninvasive tests. Methods: A 101 cirrhotic patients indicated for upper endoscopy were enrolled consecutively and subdivided according to endoscopic findings into: Group I (70 patients with EVs) and Group II (31 patients without EVs). Upper endoscopy, ultrasonography, routine lab. and Fibroscan assessment were done to all patients. Results: LSM correlated directly and significantly with the presence (p <0.001), and grading of EVs (p = 0.001). A LSM cut off value of 18.55 kPa had an AUC of 0.726, sensitivity of 74.3%, specificity of 54.8%, PPV of 78.79%, and a NPV of 48.57% for predicting the presence of EVs. Platelet count/spleen diameter ratio (PSR) inversely correlated with the EVs presence (p = 0.002), and grading (p <0.001). PSR had a cut off value of 742.17, an AUC of 0.695, sensitivity of 71% and a specificity of 58.6% (PPV of 82%, NPV of 43.14%) for EVs presence. Right lobe diameter/Albumin ratio (RLAR) correlated directly with EVs presence (p = 0.001), and grading (p =0.012). RLAR cut off value of 3.62 had AUC, sensitivity, specificity, PPV, and NPV of 0.7, 64.3%, 67.7%, 81.8%, and 45.7%, respectively for the prediction of EVs presence. Conclusion: LSM, PSR, RLAR as noninvasive methods for predicting the presence and grading of EVs are of moderate accuracy.

Background Liver cirrhosis is a diffuse process in which the anatomical structure and function of the liver are disturbed. Lipid metabolism occurs mainly in the hepatocytes. In liver cirrhosis, it is expected to detect abnormal lipid profile and abnormal neutrophil to lymphocyte ratio due to necro-inflammation and hepatocyte dysfunction. This study aimed to estimate the lipid profile in patients with liver cirrhosis and to assess its relation to the severity of the liver disease based on Child-Pugh Turcotte score and Neutrophil to Lymphocyte Ratio (NLR). Methods: This study included 500 cirrhotic patients. All patients are subjected to history taking, clinical examination, liver and renal function tests, lipid profile, and also abdomino-pelvic ultrasound. Child -Pugh score, fibrosis-4 score (FIB4), and neutrophil and platelet lymphocyte ratio were calculated. Results: A total of 500 patients were enrolled in this study; 12 patients were excluded (two patients were on the immunosuppressive drug, three patients had body mass index (BMI) >30, and seven patients took lipid-lowering drugs). Cholesterol level was significantly higher in patients with Child- Score A than B and C. Cholesterol, Low-Density Lipoprotein (LDL), and very-low-density lipoprotein (VLDL) cholesterol were significantly higher in Child B than C. A significant negative correlation was found between cholesterol level and each of FIB4 and NLR ratios. Conclusion: There was a significant negative correlation between the severity of liver cirrhosis and lipid profiles (except triglyceride), FIB4 and NLR ratio.