ISSN: 2574-8009
Authors: Ahmad R, Hasan FMM, Habib A, Bithi KF, Gomes RR*, Islam S
Background: Child-Pugh score is used as a prognostic tool while managing a patient with liver cirrhosis. It will be helpful to grade esophageal varices (EV) in cirrhotic patients by noninvasive predictors like Child-Pugh score without doing endoscopy in high risk patient or where endoscopic facilities is not available. Objective: To evaluate the Child-Pugh Score as a predictor of esophageal varices in liver cirrhosis patients. Method: This cross-sectional study was carried out at the epartment of Medicine, Gastroenterology and Hepatology of Rangpur Medical College Hospital, Rangpur from June 2023 – November 2023 over a period of six months. By purposive sampling technique total 138 liver cirrhosis patients were included in the study. Data regarding age, sex, educational status, occupational status, marital status, monthly income, history of complications and investigations we reevaluated from patients’ history sheet and documented Investigation result sheet. Collected data were analyzed with the help of SPSS software version 22. Results on continuous measurements were presented as mean & SD (min-max) and results on categorical measurements were presented as frequency & percentage. Significance will be assessed at 5% level of significance (p<0.05). Results: Mean age of the study subjects was 42.16±12.68 years with a range of 19 to 72 years. Male to female ratio was 3.1:1. Ascites was mild in 54.3% cases and marked in 20.3% cases. Hepatic encephalopathy was mild in 23.9% cases and marked in 6.5% cases. Serum albumin was <2.8g/dl in 27.5% cases, 2.8-3.5g/dl in 71.0% cases and >3.5g/dl in 1.4% cases. Serum bilirubin was <2.0mg/dl in 55.1% cases, 2.0-3.0mg/dl in 29.7% cases and >3.0mg/dl in 15.2% cases. Prothrombin time prolongation was <4 sec in64.5% cases, 4.0 -6.0sec in29.0% cases and >6 sec in 6.5% cases. Twenty-three (16.7%) study subjects had no varices. Grading of oesophageal varices were 29.7% grade I, 37.0% grade II and 16.7% grade III. Child-Pugh classes were observed 3.6% class A, 74.6% class B and 21.7% class C. Area under ROC of Child Pugh score in predicting Oesophageal varices is 0.898. Child-Pugh score at a cutoff 8 was significant in prediction of oesophageal varices with sensitivity of 0.852, specificity of 0.826, positive predictive value (PPV) of 0.961 and negative predictive value of 0.528. Nineteen (13.8%) study subjects had variceal bleeding. Conclusion: Non-invasive Child-Pugh Score can predict the presence of EV in patients with cirrhosis. Hence, its application may decrease the burden of endoscopy.
Keywords: Child Pugh Score; Liver Cirrhosis; Endoscopy; Esophageal Varices; Prothrombin Time
