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30 VALIDATING THE USEFULNESS OF DOPPLER STUDY OF HEPATIC VEINS IN PREDICTING ESOPHAGEAL VARICES IN CIRRHOTIC PATIENTS
JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY
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30
DIABETES PREDATING AND POST DATING CIRRHOSIS LIVER—A COMPARISON
VALIDATING THE USEFULNESS OF DOPPLER STUDY OF HEPATIC VEINS IN PREDICTING ESOPHAGEAL VARICES IN CIRRHOTIC PATIENTS
Objective: To compare the natural history, complication rate and mortality of cirrhotic patients with pre-existing diabetes mellitus vs diabetes developing subsequent to diagnosis of cirrhosis. Method: Cirrhotic patients admitted at medical college hospital from January 2010 to November 2011 were analyzed in a prospective comparative manner. The study group consisted of A) diabetes predating cirrhosis minimum by 8 years, B) euglycemic cirrhotics developing diabetes on subsequent follow-up, and C) control group consisting of cirrhotics without diabetes. Secondary causes of diabetes were excluded. Bonferroni test was used for multiple comparisons. Result: Of the total 189 cirrhotic patients, 97 (51.32%) were diabetic and 92 (48.67%) were non-diabetic. Among the total 97 patients with cirrhosis and diabetes, 32 (32.99%) patients were detected to have diabetes mellitus (DM) after the diagnosis of cirrhosis. Mean age was (58.06 years vs 54.25 years vs 53.60 years). Mean CTP (Child–Turcotte– Pugh) score was (9 (A) vs 11.63 (B) vs 11.02 (C); P < 0.001). Mean number of prior hospital admissions and number of decompensation episodes (3.29 vs 4.16 vs 2.25; P = 0.001) were higher in group B. Mean duration of diuretic use was more in group B (32.6 months vs 24.4 months; P < 0.05). Prevalence of gallstones was higher in cirrhotics with long standing diabetes (P < 0.001). Frequency of septic complications other than spontaneous bacterial peritonitis (SBP) were higher in the diabetic group (P < 0.01). Among the total 36 patients detected to have hepatocellular carcinoma (HCC), 16 (44.44%) were having underlying DM. Among the groups, there was no significant difference in mortality (P = 0.802). Conclusion: (i) Septic complications were more in cirrhotics with pre-existing diabetes. (ii) Incidence of SBP, HCC and mortality rate were comparable in both groups. (iii) Diabetes developing in the background of cirrhosis was easily controllable, associated with prolonged diuretic use and was having less micro and macro vascular complications.
L Thayumanavan, P Jaisankar, R Ramani, M Kannan, J Sangumani, V Sreeraj, H Hemalatha Department of Medical Gastroenterology, Madurai Medical College, Madurai Background: Hepatic venous (HV) Doppler is a sensitive aid in predicting varices in cirrhotics. Normally, triphasic flow pattern in HV changes into a biphasic and monophasic pattern in disease progression. We aimed to study HV Doppler and compare it with platelet count/splenic diameter ratio in predicting varices. Aim: (i) To study HV Doppler to predict varices and their bleeding, (ii) to compare HV Doppler and platelet count/ splenic diameter ratio to predict varices, and (iii) to compare our study with published literature. Method: Forty-nine cirrhotics attending Government Rajaji Hospital, Madurai were included. Endoscopy, ultrasonography (USG) with Doppler, liver function test (LFT) and routine investigations were done. Result: Thirty-four males and 15 females aged 27–60 years (mean 43.8 ± 10 years) formed the study group. Monophasic flow in 34/49 (69%), biphasic in 8/49 (16%) and triphasic flow in 7/49 (14.2%) were observed. Big varices were seen in 35/49. Thirty-one out of 35 with big varices showed monophasic flow, 3/35 showed biphasic flow, and 1/35 showed a normal flow (P = 0.0004). There were seven Child’s A, 30 Child’s B and 12 Child’s C cirrhotics. Thirty out of 34 with monophasic waves were decompensated. The sensitivity of loss of normal triphasic pattern in predicting large varices was 97%, specificity was 43%, and positive and negative predictive value were 81% and 86%, respectively. Forty-two of 49 had abnormal (< 909) platelet count/splenic diameter ratio. Thirty-nine of 42 with abnormal ratio had large varices. The sensitivity of platelet count/splenic diameter ratio was 93%, with specificity of 43% and positive and negative predictive values of 91% and 50%, respectively. Thirty-seven of 43 patients (86%) with a ratio < 909 showed an abnormal hepatic flow. Conclusion: Loss of triphasic flow in hepatic veins is very sensitive in predicting large varices. Platelet count/splenic diameter ratio has a high sensitivity and positive predictive value for big varices as HV Doppler. Our study is comparable to the published results in various scientific journals.
Journal of Clinical and Experimental Hepatology | March 2012 | Vol. 2 | Suppl 1 | S6–S39
S19
Abstracts
TM Ramachandran Department of Gastroenterology, Government Medical College, Calicut, Kerala
29
30
DIABETES PREDATING AND POST DATING CIRRHOSIS LIVER—A COMPARISON
VALIDATING THE USEFULNESS OF DOPPLER STUDY OF HEPATIC VEINS IN PREDICTING ESOPHAGEAL VARICES IN CIRRHOTIC PATIENTS
Objective: To compare the natural history, complication rate and mortality of cirrhotic patients with pre-existing diabetes mellitus vs diabetes developing subsequent to diagnosis of cirrhosis. Method: Cirrhotic patients admitted at medical college hospital from January 2010 to November 2011 were analyzed in a prospective comparative manner. The study group consisted of A) diabetes predating cirrhosis minimum by 8 years, B) euglycemic cirrhotics developing diabetes on subsequent follow-up, and C) control group consisting of cirrhotics without diabetes. Secondary causes of diabetes were excluded. Bonferroni test was used for multiple comparisons. Result: Of the total 189 cirrhotic patients, 97 (51.32%) were diabetic and 92 (48.67%) were non-diabetic. Among the total 97 patients with cirrhosis and diabetes, 32 (32.99%) patients were detected to have diabetes mellitus (DM) after the diagnosis of cirrhosis. Mean age was (58.06 years vs 54.25 years vs 53.60 years). Mean CTP (Child–Turcotte– Pugh) score was (9 (A) vs 11.63 (B) vs 11.02 (C); P < 0.001). Mean number of prior hospital admissions and number of decompensation episodes (3.29 vs 4.16 vs 2.25; P = 0.001) were higher in group B. Mean duration of diuretic use was more in group B (32.6 months vs 24.4 months; P < 0.05). Prevalence of gallstones was higher in cirrhotics with long standing diabetes (P < 0.001). Frequency of septic complications other than spontaneous bacterial peritonitis (SBP) were higher in the diabetic group (P < 0.01). Among the total 36 patients detected to have hepatocellular carcinoma (HCC), 16 (44.44%) were having underlying DM. Among the groups, there was no significant difference in mortality (P = 0.802). Conclusion: (i) Septic complications were more in cirrhotics with pre-existing diabetes. (ii) Incidence of SBP, HCC and mortality rate were comparable in both groups. (iii) Diabetes developing in the background of cirrhosis was easily controllable, associated with prolonged diuretic use and was having less micro and macro vascular complications.
L Thayumanavan, P Jaisankar, R Ramani, M Kannan, J Sangumani, V Sreeraj, H Hemalatha Department of Medical Gastroenterology, Madurai Medical College, Madurai Background: Hepatic venous (HV) Doppler is a sensitive aid in predicting varices in cirrhotics. Normally, triphasic flow pattern in HV changes into a biphasic and monophasic pattern in disease progression. We aimed to study HV Doppler and compare it with platelet count/splenic diameter ratio in predicting varices. Aim: (i) To study HV Doppler to predict varices and their bleeding, (ii) to compare HV Doppler and platelet count/ splenic diameter ratio to predict varices, and (iii) to compare our study with published literature. Method: Forty-nine cirrhotics attending Government Rajaji Hospital, Madurai were included. Endoscopy, ultrasonography (USG) with Doppler, liver function test (LFT) and routine investigations were done. Result: Thirty-four males and 15 females aged 27–60 years (mean 43.8 ± 10 years) formed the study group. Monophasic flow in 34/49 (69%), biphasic in 8/49 (16%) and triphasic flow in 7/49 (14.2%) were observed. Big varices were seen in 35/49. Thirty-one out of 35 with big varices showed monophasic flow, 3/35 showed biphasic flow, and 1/35 showed a normal flow (P = 0.0004). There were seven Child’s A, 30 Child’s B and 12 Child’s C cirrhotics. Thirty out of 34 with monophasic waves were decompensated. The sensitivity of loss of normal triphasic pattern in predicting large varices was 97%, specificity was 43%, and positive and negative predictive value were 81% and 86%, respectively. Forty-two of 49 had abnormal (< 909) platelet count/splenic diameter ratio. Thirty-nine of 42 with abnormal ratio had large varices. The sensitivity of platelet count/splenic diameter ratio was 93%, with specificity of 43% and positive and negative predictive values of 91% and 50%, respectively. Thirty-seven of 43 patients (86%) with a ratio < 909 showed an abnormal hepatic flow. Conclusion: Loss of triphasic flow in hepatic veins is very sensitive in predicting large varices. Platelet count/splenic diameter ratio has a high sensitivity and positive predictive value for big varices as HV Doppler. Our study is comparable to the published results in various scientific journals.
Journal of Clinical and Experimental Hepatology | March 2012 | Vol. 2 | Suppl 1 | S6–S39
S19
Abstracts
TM Ramachandran Department of Gastroenterology, Government Medical College, Calicut, Kerala