A Novel Splenic Vein Flow Volume to the Portal Vein Flow Velocity Index as a Predictor for the Degree of Esophageal Varices in Liver Cirrhosis Patients

Wicaksono, Krishna Pandu; Matondang, Sahat; Silman, Christopher; Prihartono, Joedo; Lesmana, Cosmas Rinaldi Adithya

doi:10.1159/000523757

Cited by 3 publications

(1 citation statement)

References 24 publications

(27 reference statements)

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“…Non-invasive diagnostic techniques such as liver stiffness measurement, simple and multidetector computed tomography (CT), and magnetic resonance imaging (MRI) are being used for the diagnosis of esophageal varices and to predict the risk of bleeding in cirrhotic patients [11][12][13]. Doppler ultrasonography (DUS), which is a non-invasive method, has been investigated to establish a possible connection between portal hypertension (PH) and esophageal varices [14][15][16]. The current study aims to determine the role of portal vein flow velocity (PVFV) measurement by Doppler ultrasonography as a reliable and non-invasive screening method to triage cirrhotic patients requiring endoscopic assessment for their varices.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Portal Vein Flow Velocity for Esophageal Varices in Cirrhotic Patients

Wasif Khan,

Bilal,

Khan

et al. 2023

Cureus

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Background Variceal bleeding is a life-threatening complication of cirrhosis. Traditionally, endoscopy has been utilized as a preferred modality for the detection and grading of esophageal varices. However, endoscopy is an invasive procedure and may not be readily available in resource-limited settings. To overcome this limitation, various non-invasive tests, including Doppler ultrasonography (DUS) with portal vein (PV) velocity measurement, have been investigated to predict the presence of esophageal varices (EV). This study aimed to evaluate the potential utility of portal vein flow velocity (PVFV) as a non-invasive alternative to endoscopic screening for predicting the presence of esophageal varices among cirrhotic patients. Methodology This validation cross-sectional study was carried out at the Department of Gastroenterology and Hepatology, Pakistan Kidney and Liver Institute & Research Centre (PKLI&RC), Lahore, Pakistan from June 8, 2022, to March 8, 2023. Cirrhotic patients were enrolled based on clinical, laboratory, and radiological assessments. Doppler ultrasonography was performed to measure portal vein flow velocity along other relevant indices. Subsequently, all patients underwent endoscopic evaluation to screen and grade the esophageal varices. Univariate and multivariate logistic regression analyses were performed to identify significant clinical predictors of EV based on the results of the independent sample t-tests or Mann-Whitney U tests. Receiver operating characteristic (ROC) curves were employed to determine the optimal cut-off value for portal vein flow velocity (PVFV). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated based on the identified cut-off value. A p-value ≤ 0.05 was considered statistically significant. Results A cohort of 137 cirrhotic patients was enrolled. The study population consisted of 92 males (67.2%) and 45 females (32.8%). Endoscopic screening confirmed the presence of esophageal varices in 81 patients (59.91%). A multivariate analysis revealed that aspartate aminotransferase to platelet ratio index (APRI) (p=0.008) and portal vein flow velocity (p=0.001) were significant factors associated with esophageal varices and were used for receiver operating characteristic (ROC) analysis. The area under the curve (AUC) for PVFV was 0.981, and for APRI, it was 0.711. At a cut-off value of 18 cm/sec for PVFV, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for esophageal varices were found to be 93.83%, 92.86%, 95%, 91.23%, and 93.43%, respectively. Conclusion Measurement of portal vein flow velocity using Doppler ultrasonography (DUS) is a reliable screening method for predicting the presence of esophageal varices (EV) in patients with liver cirrhosis. DUS offers several advantages, including its non-invasive nature, cost-effectiveness, and wides...

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Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Portal Vein Flow Velocity for Esophageal Varices in Cirrhotic Patients

Wasif Khan,

Bilal,

Khan

et al. 2023

Cureus

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Neutrophil extracellular traps formation may be involved in the association of propranolol with the development of portal vein thrombosis

Xu,

Zhang

et al. 2024

Thrombosis Research

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Diagnostic accuracy of shear wave elastography versus laboratory parameters as non-invasive screening tool for esophageal varices

Shehata,

Kelany,

Hassan

et al. 2024

Egypt J Intern Med

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Background Variceal hemorrhage from the rupture of esophageal varices is accompanied by a substantial mortality rate. So, newly diagnosed cirrhotic patients are recommended to perform screening esophago-gastroduodenoscopy (EGD) for identifying varices. The primary objective of the present research was to ascertain the most precise biochemical and ultrasonographic variables that have the potential to non-invasively forewarn the occurrence of varices in cirrhotic patients. The study evaluated different parameters such as aspartate aminotransferase-to-platelet ratio index (APRI), platelet count/splenic diameter (PC/SD), portal vein velocity (PVV), and splenic and hepatic stiffness in prediction of EV. Methods This is a cross-sectional study that was conducted on 100 cirrhotic patients based on clinical, laboratory, and radiological assessments. All patients were subjected to thorough clinical examinations; laboratory tests were conducted to assess liver function and calculate Child–Pugh score and non-invasive tests for detecting esophageal varices such as APRI, PC/SD, Doppler ultrasonography for assessment of PV Doppler, and hepatic and splenic elastography. All patients got an endoscopic assessment in order to examine and classify the esophageal varices. Results Based on the current study, we found that predictors for EV among the studied patients were the following: PC/SD ratio with odds ratio (OR) was 2.20, PVV with OR was 4.68, liver stiffness with OR was 1.99, and splenic stiffness with OR was 3.55. With ROC curve analysis, PVV has the best overall accuracy (85.4%) for prediction of EV with an area under the curve of 0.79 at cutoff point < 7.09 (cm/s) followed by splenic stiffness that has 82.6% overall accuracy with an area under the curve of 0.71 at cutoff point > 62.22 kPa. Conclusion PVV and splenic stiffness measurement hold potential as non-invasive markers for predicting the presence of esophageal varices in individuals with liver cirrhosis. Moreover, these markers can also aid in predicting the occurrence of advanced esophageal varices.

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A Novel Splenic Vein Flow Volume to the Portal Vein Flow Velocity Index as a Predictor for the Degree of Esophageal Varices in Liver Cirrhosis Patients

Cited by 3 publications

References 24 publications

Diagnostic Accuracy of Portal Vein Flow Velocity for Esophageal Varices in Cirrhotic Patients

Diagnostic Accuracy of Portal Vein Flow Velocity for Esophageal Varices in Cirrhotic Patients

Neutrophil extracellular traps formation may be involved in the association of propranolol with the development of portal vein thrombosis

Diagnostic accuracy of shear wave elastography versus laboratory parameters as non-invasive screening tool for esophageal varices

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