Diagnostic accurateness of AST/ALT for esophageal variceal bleeding diagnosis considering endoscopy as gold standard

Umer Bin Tariq; Iqra Shafqat; M Nabeel Mohsin; Urooj Yahya; Aysha Mushtaq; Imran Khawaja

doi:10.53730/ijhs.v7nS1.14396

Authors

Umer Bin Tariq Department of Medicine, Nawaz Sharif Medical College, Gujrat Pakistan
Iqra Shafqat Shaikh Zayed Hospital, Lahore, Punjab, Pakistan
M. Nabeel Mohsin
dr.nabeel2011@hotmail.com
Senior Registrar, Department of Internal Medicine, Mayo Hospital Lahore, Pakistan
Urooj Yahya Assistant Professor Physiology department, Swat Medical College, Khyber Medical University, Peshawar Pakistan
Aysha Mushtaq MBBS, MPhil Physiology, Demonstrator Islamic International Medical College, Rawalpindi, Punjab, Pakistan
Imran Khawaja Senior Registrar Internal Medicine, Ayub Teaching Hospital, Abbottabad, Pakhtunkhwa, Pakistan

Keywords:

AST/ALT Ratio, Chronic Liver Disease, Endoscopy, Esophageal varices, Alanine aminotransferase, Hepatic cirrhosis and Aspartate aminotransferase

Abstract

Aim: To assess the diagnostic accurateness of AST/ALT ≥ 1 for detecting esophageal varices’ considering endoscopy as gold standard. Study Design: A Cross-sectional study. Place and duration of study: The study was conducted at Lahore General Hospital and Hayatabad Medical Complex, Peshawar during the period from January 2022 to December 2022. Methodology: Using non-probability purposive sampling, 180 patients with liver cirrhosis between the ages of 18 and 65, of either sex, were selected. On endoscopy, esophageal varices were confirmed, and the AST/ALT Ratio was calculated. Results: Of the 180 patients in total, 120 (66.7%) were men and 60 (33.3%) were women. The sampled population's mean age was 51.20 ±6.9 years. The average duration of CLD was 5.42 years with a range of 2 to 10 years. 118 (65.5%) patients had an AST/ALT ratio greater than 1, 105 (58.3%) had varices detected during endoscopy, and 75 (41.7%) had no varices. The results showed that the sensitivity was computed to be 96.8%, the specificity to be 55.2%, the negative predictive value to be 90.2%, the positive predictive value to be 77.1%, the false negative rate to be 6.9% and the false positive rate to be 41.5%.

Downloads

Download data is not yet available.

References

Kothari HG, Gupta SJ, Gaikwad NR, Sankalecha TH, Samarth AR. Role of non-invasive markers in prediction of esophageal varices and variceal bleeding in patients of alcoholic liver cirrhosis from central India. The Turkish Journal of Gastroenterology. 2019 Dec;30(12):1036.

Glisic T, Stojkovic Lalosevic M, Milovanovic T, Rankovic I, Stojanovic M, Toplicanin A, Aleksic M, Milivojevic V, Martinov Nestorov J, Lolic I, Popovic DD. Diagnostic Value of Non-invasive Scoring Systems in the Prediction of Esophageal Varices in Patients with Liver Cirrhosis—Single Center Experience. Medicina. 2022 Jan 20;58(2):158.

Jabeen S, Qadir A, Benish Tufail SA. Diagnostic accuracy of a/a ratio and A/G ratio for noninvasive prediction of esophageal varices in patients of cirrhosis with hepatitis B and C. Journal of Sheikh Zayed Medical College [JSZMC]. 2018;9(3):1476-9.

Raza SH, Ahmad I, Habib A, Yousaf MA, Yousaf MJ. Aspartate aminotransferase platelet ratio index as a non-invasive predictor for esophageal varices. Pakistan Armed Forces Medical Journal. 2019 Apr 19;69(2):296-301.

Li Q, Wang R, Guo X, Li H, Shao X, Zheng K, Qi X, Li Y, Qi X. Contrast-enhanced CT may be a diagnostic alternative for gastroesophageal varices in cirrhosis with and without previous endoscopic variceal therapy. Gastroenterology Research and Practice. 2019 Oct 20;2019.

Khadka D, Prajapati S, Sudhamshu KC, Shrestha JK, Karki N, Jaishi B, Regmi K, Khadka S. Significance of non-invasive markers as predictor of esophageal varices in liver cirrhosis. JNMA J Nepal Med Assoc. 2017 Oct 1;56(208):412-6.

Yang LB, Zhao G, Tantai XX, Xiao CL, Qin SW, Dong L, Chang DY, Jia Y, Li H. Non-invasive model for predicting esophageal varices based on liver and spleen volume. World Journal of Clinical Cases. 2022 Nov 11;10(32):11743.

Faheem HA, Mohamed MA, Eid EE, Said NM. Value of Non-Invasive Scores and Modalities in Predicting the Presence of Esophageal Varices in Patients with Liver Cirrhosis. The Egyptian Journal of Hospital Medicine. 2022 Jul 1;88(1):2464-71.

Huang Y, Huang F, Yang L, Hu W, Liu Y, Lin Z, Meng X, Zeng M, He C, Xu Q, Xie G. Development and validation of a radiomics signature as a non‐invasive complementary predictor of gastroesophageal varices and high‐risk varices in compensated advanced chronic liver disease: a multicenter study. Journal of Gastroenterology and Hepatology. 2021 Jun;36(6):1562-70.

Petrisor A, Stanescu AM, Papacocea IR, Panaitescu E, Peagu R, Moldoveanu AC, Fierbinteanu-Braticevici C. Non-invasive laboratory, imaging and elastography markers in predicting varices with high risk of bleeding in cirrhotic patients. Romanian Journal of Internal Medicine. 2021 May 8;59(2):194-200.

Said M, Soliman Z, Daebes H, M El-Nahaas S, El-Serafy M. Real life application of FIB-4 & APRI during mass treatment of HCV genotype 4 with directly acting anti-viral agents in Egyptian patients, an observational study. Expert Review of Gastroenterology & Hepatology. 2019 Dec 2;13(12):1189-95.

Cifci S, Ekmen N. Evaluation of non-invasive fibrosis markers in predicting esophageal variceal bleeding. Clinical Endoscopy. 2021 May 26;54(6):857-63.

Giuffrè M, Macor D, Masutti F, Abazia C, Tinè F, Bedogni G, Tiribelli C, Crocè LS. Spleen Stiffness Probability Index (SSPI): A simple and accurate method to detect esophageal varices in patients with compensated liver cirrhosis. Annals of Hepatology. 2020 Jan 1;19(1):53-61.

Ebada HE, Ebrahim A, Elbareedy A, Salaheldin M, Allam A, Fouad RR, S Abdelmoaty A. Novel Score for Prediction of Esophageal Varices in HCV-Related‎ Chronic Liver Disease Patients‎. Afro-Egyptian Journal of Infectious and Endemic Diseases. 2021 Dec 1;11(4):343-53.

Li B, Zhang C, Zhan YT. Nonalcoholic fatty liver disease cirrhosis: a review of its epidemiology, risk factors, clinical presentation, diagnosis, management, and prognosis. Canadian Journal of Gastroenterology and Hepatology. 2018 Jul 2;2018.

Awad EA, Yousry WA, Hasan HM, ElGhandour AM. Assessment of right liver lobe size/serum albumin ratio as a new non-invasive predictor for the presence of oesophageal varices in Egyptian patients with HCV related liver cirrhosis. The Egyptian Journal of Hospital Medicine. 2020 Oct 1;81(5):2016-25.

Mahfuzzaman M, Hoque MN, Ahmed S, Bhuiyan TM. Correlation between platelet count vs spleen bipolar diameter ratio and esophageal varices in liver cirrhosis. BIRDEM Medical Journal. 2018 May 16;8(2):159-66.

Sarkar DK, Azam G, Haque M, Rahman A. Prediction of esophageal varices in liver cirrhosis by transient elastography and aspartate aminotransferase-to-platelet ratio index (APRI). Bangladesh Critical Care Journal. 2018 May 9;6(1):16-21.

Darweesh SK, Yosry A, Salah M, Zayed N, Khairy A, Awad A, Mabrouk M, Albuhairi A. Acoustic radiation forced impulse-based splenic prediction model using data mining for the noninvasive prediction of esophageal varices in hepatitis C virus advanced fibrosis. European Journal of Gastroenterology & Hepatology. 2019 Dec 1;31(12):1533-9.

Procopet B, Berzigotti A. Diagnosis of cirrhosis and portal hypertension: imaging, non-invasive markers of fibrosis and liver biopsy. Gastroenterology report. 2017 May 1;5(2):79-89.

Xu X, Jin Y, Lin Y, Hu D, Zhou Y, Li D, Wang H, Jin C. Multimodal ultrasound model based on the left gastric vein in B-viral cirrhosis: noninvasive prediction of esophageal varices. Clinical and Translational Gastroenterology. 2020 Nov;11(11).