Role of Serum Ascites Albumin Gradient (SAAG) and Portal Vein Congestion Index as Non-‎Invasive Methods for Prediction of Esophageal Varices in Cirrhotic Patients ‎

Abstract

Background and aim: Majority of cirrhotic patients develop varices, the rate of variceal bleeding is 10-30% yearly with death rate from bleeding is 17-57%. esophagogastroduodenoscopy (EGD) is an invasive and unpleasant technique carrying rare but serious complications. We aimed to investigate the serum ascites albumin gradient (SAAG) and portal vein congestion index (PCI) as non-invasive methods for prediction of esophageal varices (EV) in patients with liver cirrhosis. Patients and Methods: 125 cirrhotic patients with ascites and no past history of EGD were included. Patients were grouped into; Group I: 38 cirrhotic patients without EV. Group II: 87 cirrhotic patients with EV. Patients were subjected to full clinical evaluation, calculation of SAAG, abdominal ultrasound with a duplex study and measurement of PCI, and Esophagogastroduodenoscopy for detection and grading of esophageal varices . Results: Cirrhotic patients with EV had higher SAAG values (1.85 ± 0.24 gm/dl) than cirrhotic patients without EV (1.27 ± 0.15 gm/dl). Additionally, cirrhotic patients with EV showed a higher PCI than those without (0.16 ± 0.02 and 0.12 ± 0.01 respectively). For prediction of EV in cirrhotic patients, SAAG had AUC 0.986 (p<0.001) with cutoff >1.4 with sensitivity 97.70% and specificity 89.47% and portal congestion index, AUC was 0.974 (p<0.001) with cutoff >0.135 had sensitivity 90.80% and specificity 94.74%. Conclusion: SAAG could be used as a non-invasive predictor for the presence of EV in cirrhotic patients along with SAAG cutoff >1.4 requiring clinical attention. Combination of SAAG and PCI had a high ability to predict esophageal varices in cirrhotic patients with AUC 1.000.

Study Cardiac Dysfunction as an Early Predictor of Esophageal Varices in Patients with Liver Cirrhosis ‎

“…Numerous studies have shown that when liver cirrhosis is found, patients should be checked for the presence of EV. However, endoscopy is an invasive and unpleasant procedure that can have uncommon but serious side effects [4].…”

“…Numerous studies have tried to determine whether the existence esophageal varices may be detected by non-invasive measures, eliminating the requirement for screening endoscopy in all cirrhotic patients [3]. However, there is no universal consensus on the optimum variable for predicting EV risk [4]. In the absence of any other known causes of cardiac illness, cirrhotic patients frequently develop cirrhotic cardiomyopathy, a kind of chronic heart disease characterized by altered diastolic relaxation and/or impaired contractile response to stress [5].…”