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https://doi.org/10.14300/mnnc.2024.19065

Non-invasive predictors of primary bleeding from esophageal varices in patients with decompensated cirrhosis awaiting liver transplantation

[Internal diseases]
Vyacheslav Leonidovich Korobka; Yury Khoronko; Viktor Dmitrievich Pasechnikov; Inna Stremenkova; Roman Vyacheslavovich Korobka; Mikhail Vladimirovich Malevanny; Ekaterina S. Pak; Dmitry Viktorovich Pasechnikov;

A comparative retrospective study was conducted in 378 patients with decompensated cirrhosis who were on the waiting list for liver transplantation. An analysis of demographic, clinical and laboratory parameters, MELD-Na, Child-Turcotte-Pugh indices, FIB-4 index, APRI index, AST/ALT ratio was carried out. Liver stiffness and spleen diameter were determined, LSPS index and platelet count/spleen diameter ratio were calculated in groups of patients with the first episode of bleeding (n=170) and without it (n=208). The accumulated risks in the compared groups were assessed using a mathematical model of proportional hazards (Cox regression) in univariate and multivariate analysis. During 12 months of consecutive follow-up from the start of inclusion of patients on the waiting list for liver transplantation, primary bleeding developed in 44.97 % of cases. Based on the analysis, it was shown that independent non-invasive predictors of the first episode of bleeding are: a high fibrosis index (LS – liver stiffness), an increase in spleen diameter, a decrease in the ratio of platelet count/spleen diameter. The risk of developing the first episode of bleeding progressively increases with a LS level ≥23.1 kPa and reaches maximum values in patients awaiting liver transplantation within 12 months from the time of inclusion on the waiting list, while with a LS <23.1 kPa is significantly less.

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Keywords: liver transplantation, first episode of varix bleeding, non-invasive predictors