Correlation between serumascites albumin gradient and degree of esophageal varices in patients with hepatic cirrhosis

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1 ; 20(27): ISSN (print) ISSN (online) CLINICAL PRACTICE.,,,.,, Correlation between serumascites albumin gradient and degree of esophageal varices in patients with hepatic cirrhosis Hui Zhang, Chun Gao, Long Fang, Hong-Chuan Zhao, Shu-Kun Yao Hui Zhang, Shu-Kun Yao, Department of Gastroenterology, China-Japan Friendship Hospital, Peking University Health Science Center, Beijing , China Chun Gao, Long Fang, Hong-Chuan Zhao, Department of Gastroenterology, China-Japan Friendship Hospital, Ministry of Health, Beijing , China Correspondence to: Shu-Kun Yao, Professor, Department of Gastroenterology, China-Japan Friendship Hospital, Peking University Health Science Center, No. 2 Yinghua East Road, Beijing , China. yaoshukun6@yahoo.com.cn Received: Revised: Accepted: Published online: Abstract AIM: To explore the correlation between serumascites albumin gradient (SAAG) and the degree of esophageal varices in patients with liver cirrhosis. METHODS: Cirrhotic patients with ascites were collected and divided into three groups according to the degree of esophageal varices: mild group, moderate group and severe group. Oneway ANOVA, correlation analysis and receiver operating characteristic (ROC) curve were used for statistical analysis. RESULTS: A total of 43 cirrhotic patients were included in our study. One-way ANOVA indicated a significant difference in SAAG among the three groups (F = , P < 0.001). Spearman correlation analysis suggested a positive correlation between SAAG and esophageal varices (r = 0.759, P < ). ROC curve analysis indicated that the area under the ROC curve was 0.926, and the best cut-off value for diagnosis of moderate and severe esophageal varices was 20.5 g/l, with a sensitivity of 87.1% and a specificity of 83.3%. CONCLUSION: SAAG is correlated well with the degree of esophageal varices in cirrhotic patients, and this parameter has appreciable value in diagnosis of moderate and severe esophageal varices. Key Words: Serum-ascites albumin gradient; Esophageal varices; Liver cirrhosis; Ascites; Correlation Zhang H, Gao C, Fang L, Zhao HC, Yao SK. Correlation between serum-ascites albumin gradient and degree of esophageal varices in patients with hepatic cirrhosis. Shijie Huaren Xiaohua Zazhi 2012; 20(27): (serum-ascites albumin gradient, SAAG),, (receiver operating characteristic, ROC). 43, 3 (F = , P <0.001), Spearman r = 0.759, P <0.001, SAAG. ROC 0.926, SAAG 20.5 g/l, 87.1%, 83.3%. SAAG

2 2609, 20% [1,2]. 50%, 5%-15% [3], [4]. [3,5],.,,,.,, / [6,7], (serum ascites albumin gradient, SAAG), SAAG / ,. : (1) ; (2) ; (3) / : (1) ; (2) ; (3) ; (4) : : (CT) [8]. Child-Pugh A B C., : ; :, ; : ( ) [9]. ( ), : Child-Pugh SAAG / SAAG. 3 SAAG, mean SD Levene, (one-way ANOVA), Hochberg's GT2, ; Spearman SAAG ; 2008 ( ), 3, (receiver operating characteristic, ROC), SAAG P <0.05, SPSS17.0 (SPSS,,, ) , 31, 12, ; 18, 2, 9, 14 ; 7, 14, 17 ; Child-Pugh A 1, Child-Pugh B 24, Child- Pugh C 18 ; 33, , , SAAG 17.7 g/l 3.3 g/l; 9,, /.. (SAAG)

3 2610 ISSN (print) ISSN (online) SAAG SAAG., Specificity, SAAG,. SAAG,,, , SAAG 21.9 g/l 3.7 g/l; 22, , SAAG 26.2 g/l 3.2g/L( 1, 1). 2.2 (One-way ANOVA) 3, 3 (P = 0.959). F = , P <0.001, 3 SAAG, SAAG ( 2). F = , P <0.001,. 2.3 Spearman SAAG Spearman r = 0.759, P <0.001(P 0.01 ),. 2.4 ROC 3. 1-, ROC ( 2), 0.926, >0.9, SAAG g/l, SAAG 87.1%, 83.3%, 93.1%, 71.4%, 86%. SAAG 17.5 g/l, 100%, 50%; SAAG 24.5 g/l, 100%, 51.6%.,

4 2611 (hepatic venous pressure gradient, HVPG), HVPG>10 mmhg [10]., HVPG [3]. HVPG,.,,,., / [11,12],,, [13]. SAAG Hoefs 1978, 11 g/l, 97% [14]. Starling,,, SAAG, [15]. 3, SAAG, SAAG SAAG, SAAG, 2-3,, ROC,. ROC>0.9,, SAAG 20.5 g/l. Demirel [16] SAAG>20 g/l,.,,,,., ( ),,. 3, 3 (F = 0.765, P = 0.472), 3.,., ;,,,, ;,, SAAG,, SAAG, SAAG>20.5 g/l,, 1 D Amico G, De Franchis R. Upper digestive bleeding in cirrhosis. Post-therapeutic outcome and prognostic indicators. Hepatology 2003; 38: Carbonell N, Pauwels A, Serfaty L, Fourdan O, Lévy VG, Poupon R. Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology 2004; 40: Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007; 46: The North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction (ROC ):, 1- (1-, ). ROC ROC

5 2612 ISSN (print) ISSN (online),, of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. N Engl J Med 1988; 319: ; 10: Sharma SK, Aggarwal R. Prediction of large esophageal varices in patients with cirrhosis of the liver using clinical, laboratory and imaging parameters. J Gastroenterol Hepatol 2007; 22: Sarangapani A, Shanmugam C, Kalyanasundaram M, Rangachari B, Thangavelu P, Subbarayan JK. Noninvasive prediction of large esophageal varices in chronic liver disease patients. Saudi J Gastroenterol 2010; 16: Schuppan D, Afdhal NH. Liver cirrhosis. Lancet 2008; 371: (2003 ). 2004; 21: Groszmann RJ, Garcia-Tsao G, Bosch J, Grace ND, Burroughs AK, Planas R, Escorsell A, Garcia-Pagan JC, Patch D, Matloff DS, Gao H, Makuch R. Betablockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med 2005; 353: Giannini E, Botta F, Borro P, Risso D, Romagnoli P, Fasoli A, Mele MR, Testa E, Mansi C, Savarino V, Testa R. Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis. Gut 2003; 52: Testa R, Testa E, Giannini E, Borro P, Milazzo S, Isola L, Ceppa P, Lantieri PB, Risso D. Noninvasive ratio indexes to evaluate fibrosis staging in chronic hepatitis C: role of platelet count/spleen diameter ratio index. J Intern Med 2006; 260: Mangone M, Moretti A, Alivernini F, Papi C, Orefice R, Dezi A, Amadei E, Aratari A, Bianchi M, Tornatore V, Koch M. Platelet count/spleen diameter ratio for non-invasive diagnosis of oesophageal varices: is it useful in compensated cirrhosis? Dig Liver Dis 2012; 44: Runyon BA, Montano AA, Akriviadis EA, Antillon MR, Irving MA, McHutchison JG. The serumascites albumin gradient is superior to the exudatetransudate concept in the differential diagnosis of ascites. Ann Intern Med 1992; 117: ; 31: Demirel U, Karincaoğlu M, Harputluoğlu M, Ateş M, Seçkin Y, Yildirim B, Hilmioğlu F. Two findings of portal hypertension: evaluation of correlation between serum-ascites albumin gradient and esophageal varices in non-alcoholic cirrhosis. Turk J Gastroenterol 2003; 14: ISSN (print) ISSN (online) CN /R 2012,,, Pang ;,. [1] [2-5] ; PCR [6-7].,, [8]. 2-3 SCIE, PubMed,,, ( World Journal of Gastroenterology ( :, ( ).,,,, -, PMID ; :, ( ),,,,,,, -

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