The Right Liver Lobe Size/Albumin Concentration Ratio in Identifying Esophageal Varices among Patients with Liver Cirrhosis

Abstract

BACKGROUND It is necessity to work more on non-invasive markers like right liver lobe size/albumin concentration ratio for predicting esophageal varices. We aimed to see the right liver lobe/albumin ratio in identifying esophageal varices among patients with cirrhosis caused by hepatitis B and C. METHODS A cross-sectional study was conducted among all indoor patients admitted to the Department of Internal Medicine, Pakistan Atomic Energy Commission, General Hospital, Sector H-11/4 Islamabad, Pakistan, during May-December 2016. A non-probability purposive sampling technique was used for data collection. Diagnosed cases of cirrhosis caused by hepatitis B and C virus infection aged 25 years or more were included. A pre-designed questionnaire was used for data collection. Statistical analysis was done using SPSS software version 20. RESULTS A total number of 160 patients were included. Mean ± SD age was 56.04 ± 10.22 years, while 96 (60%) were men. Child-Turcotte-Pugh grades showed 41.88% of the patients with grade A, followed by grade B (38.12%), and grade C (20%). Esophageal varices were observed in 76.25% of the patients. The sensitivity was 86.89%, while specificity was 78.95%. The positive predictive value was 92.98% (95% confidence interval [CI] = 86.64% - 96.91%) and negative predictive value was 65.22% (CI = 49.75% - 78.64%) with a diagnostic accuracy of 85%. CONCLUSION The use of the studied non-invasive markers of portal hypertension particularly the right liver lobe size/albumin concentration ratio, can help physicians to restrict the use of endoscopic screening only to patients presenting a high probability of esophageal varices.

RLLB/Alb ratio: a promising noninvasive diagnostic marker in assessing esophageal varices in cirrhotic patients

“…Prediction of EV considering noninvasive approaches has obtained considerable attention, and numerous investigations have been carried out to invent noninvasive parameters to facilitate the anticipation of EV in CLD patients with an objective of declining cost and burden on endoscopy 20 . In our study, there were 123 (82%) patients with EV who were included, which was consistent with previously reported studies from different countries like Pakistan, India, Serbia, and Egypt 14,18,21,22 . In accordance with the previous study, 14,22 the grading of Child‐Turcotte‐Pugh, we noticed that patients with grade A were 72 (48%), which was followed by grade B (54, 36%), and grade C (24, 16%).…”

“… 20 In our study, there were 123 (82%) patients with EV who were included, which was consistent with previously reported studies from different countries like Pakistan, India, Serbia, and Egypt. 14 , 18 , 21 , 22 In accordance with the previous study, 14 , 22 the grading of Child‐Turcotte‐Pugh, we noticed that patients with grade A were 72 (48%), which was followed by grade B (54, 36%), and grade C (24, 16%). Alempijevic et al 15 identified 22.3%, 33%, 16%, and 4.3% of the patients with grade I, II, III, and IV esophageal varices, respectively, and 24.5% of the patients with no esophageal varices with an upper GI endoscopy examination.…”

“…20 In our study, there were 123 (82%) patients with EV who were included, which was consistent with previously reported studies from different countries like Pakistan, India, Serbia, and Egypt. 14,18,21,22 In accordance with the previous study, 14,22 the grading of Child-Turcotte-Pugh, we noticed that patients with grade A were 72 (48%), which was followed by grade B (54, 36%), and grade C (24, 16%). Alempijevic et al 15 Despite the promising outcomes and good correlation between the Right Liver Lobe Diameter/Serum Albumin Ratio (RLLD/Alb) ratio and grades of EV, endoscopy is yet the widely accepted and gold benchmark approach for diagnosing the EV, and the RLLD/Alb ratio yet cannot be an ideal alternative to endoscopy.…”

“…Sensitivity, specificity, positive and negative predictive value (PPV & NPV), and accuracy of the RLLD/Alb ratio were found to be 85.3%, 68.8%, 85.3%, 68.8% and 80.0%, respectively, at the best cut‐off value of 4.01. Several other studies 13,18,19,21,23 also investigated the potentiality of the RLLD/Alb ratio for noninvasively predicting the EV and explored a similar positive correlation, implying it as a promising noninvasive tool. Despite the promising outcomes and good correlation between the Right Liver Lobe Diameter/Serum Albumin Ratio (RLLD/Alb) ratio and grades of EV, endoscopy is yet the widely accepted and gold benchmark approach for diagnosing the EV, and the RLLD/Alb ratio yet cannot be an ideal alternative to endoscopy.…”

“…Sensitivity, specificity, positive and negative predictive value (PPV & NPV), and accuracy of the RLLD/Alb ratio were found to be 85.3%, 68.8%, 85.3%, 68.8% and 80.0%, respectively, at the best cut-off value of 4.01. Several other studies13,18,19,21,23 also investigated the potentiality of the RLLD/ Alb ratio for noninvasively predicting the EV and explored a similar positive correlation, implying it as a promising noninvasive tool.…”