SİROTİK HASTALARDA VARİS GELİŞİMİNİ VE VARİS KANAMASINI ÖNGÖRMEDE KLİNİK DEĞERLENDİRME VE FİBROZİS BELİRTEÇLERİNİN ETKİNLİĞİ

Abstract

The development of portal hypertension-related varice and variceal bleeding are one of the most common and fatal complications in patients with cirrhosis. In this study, the efficacy of cirrhotic patients in predicting varices, high-risk varices and variceal bleeding was investigated by laboratory, imaging, non-invasive fibrosis markers, and various mortality-related scores. Of the 139 cirrhotic patients included in the study, 108 (77.6%) had varices and 49 (35.2%) had high-risk varices; It was observed that 33 (30.5%) of the patients with varices had variceal bleeding and 12 (11.1%) had variceal bleeding in the 1-year follow-up. According to the scores obtained in our study, [(obtained parameters), threshold value, AUC, sensitivity, specificity, p value]; varices score [(charlson comorbidity index, presence of hepatic encephalopathy, PC/SD), 10,6127, AUC 0.776 (0.678-0.874), 75.9%, 71.0%, p<0.001]; variceal bleeding score [(presence of ascites, age, spleen size (mm), presence of high risk varices), -9.85, AUC 0.832 (0.750-0.919), 81.8%, 69.3%, p<0.001]; high risk varices score [(presence of ascites, PC/SD), -7.9491, AUC 0.727 (0.642-0.812), 75.5%, 64.4%, p<0.001] were revealed. Predicting the presence of varices with MELD (AUC 0.677), child-pugh (AUC 0.662), charlson comorbidity indices (AUC 0.662); significant results were observed with Lok index (AUC 0.656; 0.633) and Fibro-Q (AUC 0.655; 0.622) scores in predicting varices and variceal bleeding. In our study, no significant correlation was found between serum LOXL-2 and ELF scores and varices and variceal bleeding. Serum LOXL-2 level with total bilirubin (r -.181, p=0.033), INR (r -.247, p=0.003), MELD-Na (r -.270, p=0.001), child-pugh (r - .275, p=0.001) showed negative correlation and, with albumin showed positive correlation (r .333, p <0.001). ELF score with AST (r .429, p <0.001), ALT (r .207, p=0.015), GGT (r .200, p=0.018), total bilirubin (r .313, p <0.001), INR (r . .350, p <0.001), MELD-Na (r .382, p <0.001), child-pugh (r .417, p <0.001) showed positive correlation and, albumin (r -.487, p <0.001) and thrombocyte (r -.179, p=0.035) showed a negative correlation. In conclusion, scorings that can be used in clinical practice have been obtained, and it has been concluded that serum LOXL-2 and ELF scores can be used as prognostic serum markers in cirrhotic patients.