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

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          Abstract

          Background

          Endoscopy has long been widely used to screen for esophageal varices (EV) in cirrhotic patients. Recurrent endoscopy is a significant burden for the healthcare system of the endoscopic unit as well as uncomfortable and high costs for patients. This study intended to prognosticate Right Liver Lobe Diameter/Serum Albumin Ratio (RLLD/Alb) as a non‐invasive approach in the early diagnosis of EV among chronic liver disease (CLD) Bangladeshi patients enrolled in a specific hospital.

          Participants and Methods

          A total of 150 admitted patients with CLD were included in the study. Patients were subjected through a comprehensive biochemical checkup and upper digestive endoscopic or ultrasonographic inspection. The correlation was evaluated between the RLLD/Alb ratio and esophageal varices grades.

          Results

          The upper digestive endoscopy demonstration among 150 patients resulted in no EV in 18%, while 24% of patients was identified as EV grade I, 20% as grade II, 20% as grade III, and 18% patients as grade IV. The mean value of the RLLD/Alb ratio was 4.89 ± 1.49 (range from 2.30 to 8.45). The RLLD/Alb ratio diagnosed the EV employing the cut‐off value of 4.01 with 85.3% sensitivity and 68.8% specificity. Furthermore, it was positively correlated with the grading of EV, when this ratio increased the grading of EV increases and vice versa ( r = 0.630, p < 0.001).

          Conclusion

          The RLLD/Alb ratio is a non‐invasive parameter giving exact guidance relevant to the ascertainment of the existence of EV and their grading in chronic liver disease patients.

          Abstract

          Endoscopy, an invasive and expensive way of diagnosing esophageal varices (EV) in cirrhotic patients, which imposing a burden on the healthcare system due to the necessity of recurrent testing with unpleasant experiences. Here, we have assessed the potentiality of RLLD/Alb ratio, a non‐invasive and low cost method of precise predictability and reliability of classifying esophageal varices grade. The present study reveals RLLD/Alb ratio as a promising non‐invasive diagnostic marker of esophageal varices, which would be a fundamental tool for exhaustive variceal care.

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          Most cited references22

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          Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis.

          E Giannini, F Botta, P Borro … (2003)
          Cirrhotic patients frequently undergo screening endoscopy for the presence of oesophageal varices (OV). In the future, this social and medical burden will increase due to the greater number of patients with chronic liver disease and their improved survival. In this study, our aims were (1) to identify clinical, biochemical, and ultrasonographic parameters which might non-invasively predict the presence of OV in patients with liver cirrhosis; (2) to evaluate the reproducibility of the obtained results in a different, although related, further group of patients; and (3) to assess the predictiveness of the identified rules in patients with compensated cirrhosis. In the first part of the study we retrospectively evaluated the presence of OV in 145 cirrhotic patients, and in the second part we evaluated the reproducibility of the study results in a subsequent group of 121 patients. Finally, we evaluated these parameters in a subgroup of 145 patients with compensated disease. All 266 patients underwent a complete biochemical workup, upper digestive endoscopy, and ultrasonographic measurement of spleen bipolar diameter. Platelet count/spleen diameter ratio was calculated for all patients. The prevalence rates of OV were 61% and 58% in the first and second groups of patients, respectively. In the first part of the study, we found that platelet count, spleen diameter, platelet count/spleen diameter ratio, and Child- Pugh class were significantly different among patients with or without OV, although the platelet count/spleen diameter ratio was the only parameter which was independently associated with the presence of OV in a multivariate analysis. A platelet count/spleen diameter ratio cut off value of 909 had 100% negative predictive value for a diagnosis of OV. This result was reproduced in the second group of patients as well as in patients with compensated disease. In a cost-benefit analysis, screening cirrhotic patients according to the "platelet count/spleen diameter ratio strategy" was far more cost effective compared with the "scope all strategy". The platelet count/spleen diameter ratio is the only parameter which is independently associated with the presence of OV, and its negative predictive value is reproducible. Its use is of value even in the subgroup of patients with compensated disease, and it is also cost effective.
          Article 0 comments Cited 94 times – based on 0 reviews     Review now
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            Endoscopic screening for varices in cirrhosis: findings, implications, and outcomes.

            Michael D. Jensen (2002)
            At least two thirds of cirrhotic patients develop esophageal varices during their lifetime. Severe upper gastrointestinal (UGI) bleeding as a complication of portal hypertension develops in about 30%-40% of cirrhotics. Despite significant improvements in the early diagnosis and treatment of esophagogastric variceal hemorrhage, the mortality rate of first variceal hemorrhage remains high (20%-35%). Primary prophylaxis, the focus of this article, is treatment of patients who never had previous variceal bleeding to prevent the first variceal hemorrhage. The potential of preventing first variceal hemorrhage offers the promise of reducing mortality, morbidity, and associated health care costs. This article (1) reviews endoscopic grading of size and stigmata for esophageal and gastric varices, (2) describes data on prevalence and incidence of esophageal and gastric varices from prospective studies, (3) discusses independent risk factors from multivariate analyses of prospective studies for development of first esophageal or gastric variceal hemorrhage and possible stratification of patients based on these risk factors, (4) comments on the potential cost effectiveness of screening all newly diagnosed cirrhotic patients and treating high-risk patients with medical or endoscopic therapies, and (5) recommends further studies of endoscopic screening, stratification, and outcomes in prospective studies of endoscopic therapy. The author's recommendations are to perform endoscopic screening for the following subgroups of cirrhotics: all newly diagnosed cirrhotic patients and all other cirrhotics who are medically stable, willing to be treated prophylactically, and would benefit from medical or endoscopic therapies. Exclude patients who are unlikely to benefit from prophylactic therapies designed to prevent the first variceal hemorrhage, those with short life expectancy, and those with previous UGI hemorrhage (they should have already undergone endoscopy). For low or very low risk cirrhotic patients-those found to have no varices or small varices without stigmata-repeat endoscopy is recommended because screening for progression may be warranted in 2 or more years.
            Article 0 comments Cited 42 times – based on 0 reviews     Review now
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              Portal hypertension and variceal bleeding--unresolved issues. Summary of an American Association for the study of liver diseases and European Association for the study of the liver single-topic conference.

              Guadalupe García-Escalante, R J Groszmann, Jaime Bosch (2008)
              Article 0 comments Cited 20 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Ashekul Islam:
                ORCID: https://orcid.org/0000-0003-3395-0320
                ashekbmb@mbstu.ac.bd
                Journal
                Journal ID (nlm-ta): J Clin Lab Anal
                Journal ID (iso-abbrev): J Clin Lab Anal
                Journal ID (doi): 10.1002/(ISSN)1098-2825
                Journal ID (publisher-id): JCLA
                Title: Journal of Clinical Laboratory Analysis
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 0887-8013
                ISSN (Electronic): 1098-2825
                Publication date (Electronic): 08 July 2022
                Publication date Collection: August 2022
                Volume: 36
                Issue: 8 ( doiID: 10.1002/jcla.v36.8 )
                Electronic Location Identifier: e24589
                Affiliations
                [ 1 ] Department of Gastroenterology Chittagong Medical College Hospital Chattogram Bangladesh
                [ 2 ] Department of Biochemistry and Molecular Biology Mawlana Bhashani Science and Technology University Tangail Bangladesh
                [ 3 ] Department of Medicine Chittagong Medical College Chattogram Bangladesh
                [ 4 ] Department of Microbiology Noakhali Science and Technology University Noakhali Bangladesh
                Author notes
                [*] [* ] Correspondence

                Ashekul Islam, Department of Biochemistry and Molecular Biology, Mawlana Bhashani Science and Technology University, Tangail 1902, Bangladesh.

                Email: ashekbmb@ 123456mbstu.ac.bd

                Author information
                https://orcid.org/0000-0003-3395-0320
                Article
                Publisher ID: JCLA24589 Other ID: JCLA-22-1211.R1
                DOI: 10.1002/jcla.24589
                PMC ID: 9396198
                PubMed ID: 35808890
                SO-VID: 1c4d5820-40a2-4a78-a14f-78407a8de20f
                Copyright © © 2022 The Authors. Journal of Clinical Laboratory Analysis published by Wiley Periodicals LLC.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                Date revision received : 16 June 2022
                Date received : 15 April 2022
                Date accepted : 25 June 2022
                Page count
                Figures: 5, Tables: 2, Pages: 6, Words: 3644
                Categories
                Subject: Research Article
                Subject: Research Articles
                Custom metadata
                source-schema-version-number 2.0
                cover-date August 2022
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.1.7 mode:remove_FC converted:23.08.2022

                ScienceOpen disciplines: Clinical chemistry
                Keywords: esophageal varices (ev),liver cirrhosis,right liver lobe diameter/serum albumin ratio,ultrasonography,upper digestive endoscopy
                Data availability:
                ScienceOpen disciplines: Clinical chemistry
                Keywords: esophageal varices (ev), liver cirrhosis, right liver lobe diameter/serum albumin ratio, ultrasonography, upper digestive endoscopy

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