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. 2023 Sep 15:2023:7938732.
doi: 10.1155/2023/7938732. eCollection 2023.

Prediction of Esophageal Varices in Viral Hepatitis C Cirrhosis: Performance of Combined Ultrasonography and Clinical Predictors

Puwitch Charoenchue  1 , Wittanee Na Chiangmai  1 , Amonlaya Amantakul  1 , Wasuwit Wanchaitanawong  2 , Taned Chitapanarux  2 , Suwalee Pojchamarnwiputh  1
Affiliations

Prediction of Esophageal Varices in Viral Hepatitis C Cirrhosis: Performance of Combined Ultrasonography and Clinical Predictors

Puwitch Charoenchue et al. Int J Biomed Imaging. .

Abstract

Objectives: This study is aimed at evaluating the diagnostic performance of clinical predictors and the Doppler ultrasonography in predicting esophageal varices (EV) in patients with hepatitis C-related cirrhosis and exploring the practical predictors of EV.

Methods: We conducted a prospective study from July 2020 to January 2021, enrolling 65 patients with mild hepatitis C-related cirrhosis. We obtained clinical data and performed grayscale and the Doppler ultrasound to explore the predictors of EV. Esophagogastroduodenoscopy (EGD) was performed as the reference test by the gastroenterologist within a week.

Results: The prevalence of EV in the study was 41.5%. Multivariable regression analysis revealed that gender (female, OR = 4.04, p = 0.02), platelet count (<150000 per ml, OR = 3.13, p = 0.09), splenic length (>11 cm, OR = 3.64, p = 0.02), and absent right hepatic vein (RHV) triphasicity (OR = 3.15, p = 0.03) were significant predictors of EV. However, the diagnostic accuracy indices for isolated predictors were not good (AUROC = 0.63-0.66). A combination of these four predictors increases the diagnostic accuracy in predicting the presence of EV (AUROC = 0.80, 95% CI 0.69-0.91). Furthermore, the Doppler assessment of the right hepatic vein waveform showed good reproducibility (κ = 0.76).

Conclusion: Combining clinical and Doppler ultrasound features can be used as a screening test for predicting the presence of EV in patients with hepatitis C-related cirrhosis. The practical predictors identified in this study could serve as an alternative to invasive EGD in EV diagnosis. Further studies are needed to explore the diagnostic accuracy of additional noninvasive predictors, such as elastography, to improve EV screening.

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Conflict of interest statement

The authors declare no financial interests or other potential conflicts of interest related to this study. The machines used in the study were standard equipment available for service use in the institute.

Figures

Figure 1
Figure 1
The study flow diagram shows no exclusion or technical failure.
Figure 2
Figure 2
Grayscale US image shows the measurement of the splenic long and short axes.
Figure 3
Figure 3
Assessment of the main portal vein: (a) grayscale US measuring a maximal diameter and (b) Doppler US measuring a maximal and minimal velocity and flow volume.
Figure 4
Figure 4
Assessment of the right hepatic vein for velocity and waveform type: (a) normal triphasic or (b) absence of triphasicity.
Figure 5
Figure 5
Hepatic artery assessment for PSV, EDV, and RI.
Figure 6
Figure 6
The receiver operating characteristic (ROC) curve shows the diagnostic accuracy of combined predictors for diagnosing esophageal varices (EV) compared to isolated parameters. The area under the curve (AUROC) for the combined predictor model was 0.80 (95% CI 0.69-0.91), indicating good diagnostic accuracy, while the AUROC for isolated parameters ranged from 0.62 to 0.65.
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