Hyaluronic Acid, Spleen Size and Prothrombin Time Predict the Existence of High-Risk Esophageal Varices in Non-Viral Cirrhosis in Real Life

Abstract

Abstract Background and aims. Biomarkers are a simple and inexpensive way to replace the invasive diagnostic test(1,2). Portal hypertension screening recommendations in cirrhotic patients propose two such biomarkers: the platelet count and liver elastography. This recommendation derives from studies on viral cirrhosis(3). Viral cirrhosis is biologically and histologically different from steatosis related cirrhosis and traditional biomarkers used for high-risk varices screening might not be of use in this category. We aimed to evaluate their utility compared to other biomarkers for the prediction of high-risk varices of non-viral etiology in cirrhotic patients. Methods. Our current study is a monocentric, real-life, cross-sectional analysis of non-viral cirrhosis patients. Results. 50 patients with suspected cirrhosis, who underwent upper gastrointestinal endoscopy, were included prospectively for over 8 months and 41 were analyzed. The etiology was steatohepatitis (alcohol and non-alcohol related steatohepatitis). Hyaluronic acid (AUC 0.866, r =0.600), prothrombin time (AUC 0.708, r =0.445) and spleen size (AUC 0.763, r =0.337) significantly correlated with high-risk esophageal varices. In the meantime, liver stiffness was difficult to obtain and only correlated modestly with high-risk esophageal varices and platelet count was a poor predictor of high-risk esophageal varices in this mainly steatosis related cohort of cirrhotic patients. Conclusion. We proposed hyaluronic acid, spleen size and prothrombin time as alternatives biomarkers for portal hypertension in steatohepatitis patients. Their potency should be further proven in larger studies.