Evaluation of Non-invasive Scores for Predicting Portal Hypertensive Gastropathy Severity in Egyptian Patients with Liver Cirrhosis

Abstract

Background and study aim: Mucosal ectasia of the stomach in portal hypertension is recognized as portal hypertensive gastropathy (PHG). Liver stiffness measurement (LSM) recorded by transient elastography (Fibroscan) has a substantial association with portal hypertension and the anticipation of esophageal varices (EVs). We aimed to understand the contribution of LSM, liver stiffness-spleen size-to-platelet ratio score (LSPS), platelet count/spleen diameter ratio (PSR), and right lobe diameter/albumin ratio (RLAR) in predicting PHG occurrence and extent in cirrhotic patients. Patients and Methods: 192 cirrhotic patients were categorized into Group 1 (48 patients with PHG and EVs), Group 2 (48 patients with EVs), Group 3 (48 patients with PHG), and Group 4 (48 patients with neither PHG nor EVs as control). All patients underwent upper endoscopy, Ultrasonography, routine lab. and Fibroscan evaluation. Results: PSR correlated inversely while RLAR, LSM, and LSPS correlated directly with PHG presence and severity (P <0.001). PSR threshold of 3.11 predicted PHG with AUC 0.648, sensitivity 79.2%, specificity 39.6%, PPV 56.7%, and NPV 65.5%. LSM predicted PHG at a threshold of >18.35 kPa with an AUC of 0.622, sensitivity 76%, specificity 52.1%, PPV 61.3%, and NPV 68.5%. LSPS cut-off value of >2.12 predicted PHG with an AUC of 0.680, sensitivity 76%, specificity 53.1%, PPV 61.9%, and NPV 68.9%. Conclusion: LSM, LSPS, PSR, and RLAR are easy, non-invasive, inexpensive modalities predicting PHG existence and severity in cirrhotic patients.