SİROZLU HASTALARDA ÖZOFAGUS VARİSİNİ PREDİKTE EDEN NON-İNVAZİF, BASİT VE YENİ BİR BELİRTEÇ: TROMBOSİT SAYISI/DALAK BOYUTU ORANI A Non-Invasive Simple And New Marker Predicting Esophageal Varices In Cirrhotic Patients: Platelet Count/ Spleen Size Ratio

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OZET Amac: Ozofagus varisleri siroz hastalarinda portal hipertansiyonun ciddi bir sonucudur. Varisleri degerlendirmede endoskopi en sik kullanilan yontemdir. Calismamizda kronik hepatit B ve/veya hepatit C’ye bagli karaciger sirozu olan hastalarda ozofagus varislerinin varligi ve derecesinin ongorulmesinde noninvaziv parametreler degerlendirildi. Gerec ve Yontemler: Calismaya 2009-2015 yillari arasinda Gaziantep Universitesi Tip Fakultesi Gastroenteroloji Bilim Dali’nda takip edilen, hepatit B ve/veya hepatit C virusu nedeniyle karaciger sirozu tanisi konulan 324 hasta alindi. Hastalarin demografik, klinik, laboratuvar, radyolojik (dalak boyutu, portal ven capi, portal ven akimi) ve endoskopik bulgulari retrospektif olarak dosya taramasi ile elde edilerek varis ile iliskisi degerlendirildi. Bulgular: Calismaya alinan 324 hastanin 178 (%54.9)’i erkek, 146 (%45.1)’si kadin olup yas ortalamasi 57.4±11.2 (27-87) idi.164’u kronik hepatit B, 160’i ise kronik hepatit C’ye bagli siroz idi. Hastalarin 69 (%21.3)’unda ozofagus varisi saptanmazken, 255 (%78.7) hastada ozofagus varisi mevcuttu. 255 hastanin 97 (%29.9)’sinde grade 1, 129 (%39.8)’unda grade 2, 29 (%9.0)’unda ise grade 3 ozofagus varisi goruldu. Ozofagus varisi olan ve olmayan gruplar arasinda dalak boyutu, portal ven capi, trombosit sayisi, trombosit sayisi/dalak boyutu orani arasinda anlamli fark bulundu (p=0001). Varis varligini predikte eden trombosit sayisi/dalak boyutu orani cutoff degeri ?846 (sensitivite %90, spesifite %91) olarak saptandi. Trombosit sayisi/dalak boyutu orani 846 ve altindaki degerler icin varis varligini gostermedeki pozitif prediktif degeri %97.4 olup negatif prediktif degeri %71.5 bulundu. Sonuc: Sirozlu hastalarda ozofagial varis varligini yuksek sensitivite ve spesifitesi ile predikte edebilecek bir parametre olarak trombosit sayisi/dalak boyutu orani yeni ve non-invaziv bir belirtec olarak kullanilabilir. Anahtar Sozcukler: Siroz; Portal hipertansiyon; Ozofagus varisi; Non- Invaziv belirtec ABSTRACT Aim: Esophageal varices are a serious consequence of portal hypertension in patients with liver cirrhosis. Endoscopy is the most commonly used method for the evaluation of esophageal varices. The aim of this study is to evaluate non- invasive predictors of presence and size of esophageal varices in chronic hepatitis B or C positive liver cirrhosis patients. Material and Methods: 324 cirrhotic patients with hepatitis B or C who applied to Gastroenterology clinic of Gaziantep University between the years of 2009-2015 were included in the study. Demographic, clinical, laboratory, radiological (spleen size, portal veindiameter, portal flow), and endoscopic (presence and size of esophageal varices) findings were obtained from the patients files as retrospectively. The relationship between presence of varices and laboratory/radiological findings were assessed. Results: A total of 324 patients were included. The mean age was 57.4±11.2 years; 178 (54.9%) were men, and 146 (45.1%) women. 164 patients were chronic hepatitis B related cirrhosis and 160 were chronic hepatitis C related cirrhosis. Esophageal varices were present in 255 (78,7%) patients and in 69 patients (21.3%) had no esophageal varices. Out of 255 patients, 97 (29.9%) had grade 1, 129 (%39.8) grade 2, 29 (%9) grade 3 varices. Spleen size, portal vein diameters, platelet count and platelet count/spleen size ratio had statistically significant difference in varices group when compared with the non-varix group (p=0001). In the estimation of varices; cut off value of platelet count/spleen size ratio was found as ?846 with sensitivity of 90 %, and specificity of 91 %, positive and negative predictive values of 97,4% and 71,5%, respectively. Conclusion:The ratio of platelet count / spleen size as a parameter with high sensitivity and specificity which can predict the presence of esophageal varices in patients with cirrhosis, can be used as a new and noninvasive marker. KeyWords: Cirrhosis; Portal hypertension; Esophageal varix; Non-Invasive marker

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