COMPARISON OF DIAGNOSTIC ACCURACY OF SERUM ALBUMIN AND ENDOSCOPY FOR ESOPHAGEAL VARICES IN PATIENTS OF CHRONIC LIVER DISEASE

Mahmood Khan*, Fayaz Hussain Khoso, Kanchan Devi, Om Parkash, Ravi Kumar, and Akash Mandhan

ABSTRACT

Background: Chronic liver disease (CLD) is characterized by series of progressive destruction followed by regeneration of liver parenchyma that leads to fibrosis and cirrhosis. Presently, esophagogastroduodenoscopy (EGD) is said to be gold standard test in diagnosis of esophageal Varices (EVs), but it is a highly skillful interventional procedure so needs subjective expertise. In contrast, serum albumin can be useful tool in prediction of esophageal varices. Objective: The aim of this study is to explore the diagnostic efficacy of serum albumin for prediction of esophageal varices in patients suffering from chronic liver disease by taking EGD as gold standard investigation for EVs. Material & Methods: This was a cross sectional study conducted at Department of Medicine, LUMHS Hospital hyderbad/Jamshoro and department of Gastroenterology, AIMS Hospital, Hyderabad from January 2018 to November 2018. The study was designed on non-probability, consecutive sampling technique. Informed written consent was received from all patients. Demographic details (name, gender, age and contact) were also noted. Venous blood sample was taken from all patients by using 5cc disposable syringes. The samples were brought to LUMHS Hospital laboratory for serum albumin levels assessment. The results were assessed and patients were labeled either positive or negative for esophageal varices. EGD was done in all patient by a consultant gastroenterologist. Presence or absence of the varices was noted. 2x2 table was applied to calculate the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of serum albumin levels as compared to known gold standard test esophagogastroduodenoscopy. Results: In this study the mean age of the patients was noted as 53.63±15.32 years. The male to female ratio of the patients noted was 2.3:1. EVs on serum albumin levels were found positive in 39 (41.1%) cases & EGD was found positive in 37 (38.95%) cases. The sensitivity of esophageal varices on serum albumin was 81.1% and specificity 84.5%. The PPV value was 76.9%, NPV value was 87.5% and diagnostic accuracy of esophageal varices on serum albumin was 83.2%. Conclusion: Based on results of this study we are of opinion that serum albumin is a reliable predictor and first line diagnostic tool for esophageal varices development in patients of chronic liver disease.

Keywords: Serum Albumin, Esophageal Varices (EVs), Chronic Liver Disease (CLD), Esophagogastroduodenoscopy (EGD).