Portal hypertension commonly accompanies liver cirrhosis, and development of oesophageal varices is among the major complications of portal hypertension. Patients with cirrhosis should be screened for the presence of oesophageal varices when portal hypertension is diagnosed. To reduce the increasing burden of endoscopy units, some studies have attempted to identify parameters for non‐invasive prediction of the presence of oesophageal varices.
We read with great interest the article by Giannini et al (Gut 2003;52:1200–5). Besides the confirmation of proposed platelet count:spleen diameter ratio in predicting the presence of oesophageal varices in patients with liver cirrhosis, we introduced a new measurement for predicting oesophageal varices. Our preliminary study included 58 patients with cirrhosis who underwent a complete biochemical investigation, upper digestive endoscopy and ultrasonographic examination. Right liver lobe diameter:albumin ratio has been calculated and correlated with the presence and grade of oesophageal varices. All patients gave their written consent, and the ethical committee of our institution permitted our study.
Table 1 lists the clinical features of the study patients. Right liver lobe diameter:albumin ratio and grade of oesophageal varices (table 2) seems to have a significant correlation (Spearman's test for non‐parametric correlation r = 0.441; p<0.01).
Table 1 Clinical data of study patients with cirrhosis.
| Sex (M/F) | 40/18 |
| Mean (SD) age (years) | 53.07 (13.09) |
| Age range (years) | 17–79 |
| Aetiology of liver disease (alcoholic/infective/immune/other) | 26/13/12/7 |
| Child–Pugh class (A/B/C) | 31/23/4 |
| Mean (SD) size of the right liver lobe | 156 (22.72) |
| Mean (SD) albumin concentration | 30.84 (7.28) |
| Mean (SD) albumin:right liver lobe diameter ratio | 5.43 (1.79) |
| Oesophageal varices (grade 0/I/II/III/IV) | 14/11/20/12/1 |
Table 2 Values of the right liver lobe diameter:albumin ratio.
| Varices | Right liver lobe diameter:albumin ratio | ||
|---|---|---|---|
| Mean (SD) | Minimum | Maximum | |
| Grade 0 | 4.14 (1.29) | 2.76 | 6.82 |
| Grade I | 5.25 (1.23) | 3.92 | 7.63 |
| Grade II | 5.68 (1.29) | 3.40 | 8.48 |
| Grade III | 6.66 (2.55) | 4.07 | 11.44 |
| Grade IV | 6.86 | — | — |
Previously published studies reported that the platelet count:spleen size ratio is a good predictor of oesophageal varices. We investigated serum albumin concentration as a parameter of liver function in combination with right liver lobe size. Despite a good correlation of these ratios and grade of oesophageal varices, it is unlikely that these indexes could be used to exclude patients from initial screening endoscopy. Nevertheless, these indexes may serve for selection of patients in need for more frequent endoscopy. Using these indexes will enable identification of patients at higher risk for the development of oesophageal varices. It will provide insight into the relationships between clinical, biochemical, haematological and imaging abnormalities, and the development of clinically significant oesophageal varices.
The right liver lobe diameter:albumin and platelet count:spleen diameter ratios are non‐invasive parameters that can provide accurate information pertinent to determining the presence of oesophageal varices and their grading in patients with liver cirrhosis.
Footnotes
Competing interests: None.