The influence of some factors on presence of varices and variceal bleeding in liver cirrhosis patients

Czech version

Authors: L. Husová ¹; P. Husa ²; P. Ovesná ³
Authors‘ workplace: Interní gastroenterologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MU Dr. Aleš Hep, CSc. ¹; Klinika infekčních chorob Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MU Dr. Petr Husa, CSc. ²; Institut biostatistiky a analýz Lékařské a Přírodovědecké fakulty MU Brno, vedoucí doc. RNDr. Ladislav Dušek, Ph. D. ³
Published in: Vnitř Lék 2011; 57(1): 61-71
Category: Original Contributions

Overview

Study aim:
The aim of the study was to identify non‑invasive investigations that would provide a sufficiently reliable prediction of the presence of varices in patients with liver cirrhosis (LC) and identification of patients in a risk of variceal bleeding.

Patient sample and methodology:
As part of a prospective evaluation, 165 patients with alcoholic LC admitted to the Department of Internal Hepatology and Gastroenterology of the Medical School, Masaryk University in Brno between 2007– 2009 were divided according to the presence of varices and variceal bleeding into three groups: I. patients with LC and varices with no variceal bleeding (N = 50), II. patients with LC with no varices and thus no variceal bleeding (N = 51), III. patients with LC and varices with confirmed variceal bleeding (N = 64). A statistical evaluation was performed of a range of haematological and biochemical parameters, spleen size and a thrombocyte, leucocyte and erythrocyte count to spleen size ratio.

Results:
Patients with varices (groups I and III) had, compared to patients with no varices (group II),a significantly larger spleen, lower thrombocyte count, lower plasma fibrinogen level, extended prothrombin time (higher INR), lower plasma GGT activity and lower erythrocyte, leucocyte and thrombocyte count to spleen size ratio. In the present cohort, statistically significant factors for the presence of variceal bleeding included lower erythrocyte count and lower level of haemoglobin, i.e. the expected effect of bleeding, lower fibrinogen serum levels, lower serum ALP activity, lower total serum protein and serum albumin, higher plasma levels of uric acid and lower leucocyte or erythrocyte count to spleen size ratio.

Conclusion:
Using common haematological and biochemical parameters together with spleen size enables, even without endoscopic examination, highly reliable prediction of the presence of varices and identification of patients in a high risk of variceal bleeding. When these non‑invasive methods are used, it is possible to eliminate the need for the invasive endoscopic examination that is frequently poorly tolerated by the patients and economically demanding.

Key words:
liver cirrhosis – variceal bleeding – predictive parameters

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