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Khirurgii

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Year 2022 Vol. 30 No 1

GENERAL & SPECIAL SURGERY

A.G. SKURATOV, A. N. LYZIKOV, V.M. MITSURA

ASSESSMENT OF PORTAL HYPERTENSION SEVERITY IN LIVER CIRROSIS

Gomel State Medical University, Gomel,
Republic of Belarus

Objective. Development of a non-invasive assessing diagnostic and severity grading accuracy of portal hypertension in cirrhosis of the liver.
Methods. To identify diagnostically significant indicators, a statistical analysis of the data of laboratory and instrumental diagnostics was carried out in 60 patients with liver cirrhosis. The following biochemical indicators were determined: general and biochemical blood tests, coagulogram, general urine analysis; the level of interleukin-6 (IL-6), matrix metalloproteinases 1 and 9 (MMP-1, MMP-9), tissue inhibitor of matrix metalloproteinase 1 (TIMP-1), hepatocyte growth factor (HGF); abdominal ultrasound examination, esophagogastroscopy. The index of the ratio of the number of blood platelets (N×109 / L) to the transverse size (D) of the spleen in millimeters (PSR - Platelet count to Spleen diameter Ratio) was calculated: PSR = NTr / D spleen.
Results. The following indicators turned out to be diagnostically significant (predictive values based on ROC analysis are presented): blood levels of IL-6 (>19.9 pg/ml), MMP-1 (>8.06 ng/ml), cholesterol (≤4,5mmol/L), portal vein diameter (>13 mm), PSR (≤1.89). Diagnostic methods for cirrhosis and portal hypertension was developed, based on a point assessment of a set of laboratory and instrumental criteria (AUC = 0.931; p <0.001). The method can be used in a complex of medical services aimed at diagnosis of portal hypertension severity in patients with cirrhosis of the liver, as well as medical prevention of life-threatening complications of the disease.
Conclusion. The developed method makes it possible to identify patients with a «severe» form of portal hypertension, to recommend an unscheduled FEGDS with an endoscopic assessment of the risk of bleeding, and to carry out preventive and therapeutic procedures. If a low probability of a “severe” form of PH is identified, FEGDS should be refrained from if the patient has absolute or relative contraindications to the use of this diagnostic method.
The method can be used in a complex of medical services aimed at diagnosing the severity of portal hypertension against the background of liver cirrhosis.

Keywords: liver cirrhosis, portal hypertension, gastroesophageal varices, diagnosis of the disease severity
p. 20-27 of the original issue
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Address for correspondence:
246050, Belarus, Gomel,
Lange st. 5,
Gomel State Medical University,
the Department of Surgery No1 with the Course
of Cardiovascular Surgery,
tel.: +375447957922,
e-mail: alexskuratov@mail.ru,
Skuratov Alexander G.
Information about the authors:
Skuratov Alexander G., PhD, Associate Professor of the Department of Surgery No.1 with the Course of Cardiovascular Surgery, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0002-1994-1156
Lyzikov Anatoly N., MD, Professor of the Department of Surgery No1 with the Course of Cardiovascular Surgery, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0002-4668-6007
Mitsura Viktor M., MD, Associate Professor of the Department of Infectious Diseases, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0002-0449-5026
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