Right liver lobe diameter to serum albumin ratio and blood ammonia level as non-invasive predictor for the presence of esophageal varices and the risk of bleeding in patient of cirrhosis of liver

Background: Esophageal varices (EV), a dangerous complication of cirrhosis, are expensive and inconvenient to diagnose with frequent endoscopies. This study explores using blood tests (ammonia level) and a liver size measurement (right lobe diameter to albumin ratio) as simpler ways to identify patients with EV and at risk of bleeding.
Materials and Methods: A cross-sectional study was conducted at BIRDEM General Hospital from April 2019 to June 2021 to investigate non-invasive predictors of esophageal varices in patients with liver cirrhosis. 153 patients with cirrhosis were enrolled and underwent detailed medical history, physical examination, and laboratory tests. Data was collected using standardized forms, checked for accuracy, and analyzed using SPSS 23 software.
Results: The study found that patients with esophageal varices (EV) had significantly higher blood ammonia levels (41.13 µmol/l ± 11.22) compared to those without EV (p < .05). Additionally, the right liver lobe diameter was larger in patients with EV (153.92 mm ± 6.54) and the ratio of this diameter to their serum albumin level was also significantly higher (3.89 ± 0.91, p < .05).Interestingly, a ratio of right liver lobe diameter to serum albumin greater than or equal to 2.95 identified patients with EV with 100% sensitivity and 86.4% specificity, offering a high degree of accuracy (86.4%). Blood ammonia levels above 33.35 µmol/l showed slightly lower accuracy (78.4%) with 79.4% sensitivity and 72.7% specificity. The study also followed the patients for bleeding complications. Nearly 38.4% experienced bleeding within 3 months, and a significant portion (65%) had both high right liver lobe diameter to albumin ratio and elevated blood ammonia levels at the 6-month mark.
Conclusion: This study found that the higher value of both the Right Liver Lobe Diameter to Serum Albumin Ratio and Blood Ammonia Level were significantly associated with the presence of esophageal varices (EV) among patients with liver cirrhosis and both of them can be used as non-invasive predictor of EV among patients with liver cirrhosis. However, further study is recommended to validate these findings.