Portal Vein Pulsatility Pattern in Cirrhotic Patients with Portal Hypertension: A Tool to Assess Severity of Liver Disease in a Low Setting Tertiary Hospital; A Cross-sectional Study

Abstract

Introduction: Liver Cirrhosis is associated with significant morbidity and mortality. Simple parameters such as portal vein pulsatility index(PI) and complete spectral widening(CSW) have been observed in some studies to reflect early alterations in portal hemodynamics associated with the severity of liver disease. Methodology: It was a cross-sectional study, and a purposive non-probability sampling technique was used for selecting cases. Results: Among 33 patients with liver disease, 5 (15.2%) of them were in Child-Pugh class A, 10 (30.3%) in class B and 18 (54.5%) in class C. In the healthy group, 97.0% (32 of 33) had PI between 0.2–0.5 and 3.0% (1 of 33) had pronounced pulsatility > 0.5 whereas, in the cirrhotic patients, 63.6% (21 of 33) had PI between < 0.2 and 36.4% (12 of 33) had a pulsatility index between 0.2–0.5. The mean PI in Child-Pugh class A was 0.28 ± 0.11, in Child-Pugh class B 0.20 ± 0.03, and in Child-Pugh class C, it was 0.14 ± 0.05, indicating that the PI becomes lower with increasing severity of cirrhosis. Complete spectral widening (CSW) was present in 60.6% of patients with cirrhosis (20 of 33) and none of the healthy subjects in the control group (0 of 33). Conclusion: A decrease in the pulsatility index and the presence of complete spectral widening are valuable predictors of cirrhotic patients with portal hypertension, with alterations become significantly more pronounced as disease severity increases. However, this study could emphasize the role of duplex Doppler in recognizing disease in its early stages and determining disease severity in low setting tertiary hospital.