JPSIM Journal of Pakistan Society of Internal Medicine J Pak Soc Intern Med 2709-8729 2710-0804 Pakistan Society of Internal Medicine 10.70302/jpsim.v5i3.2451 jpsim.v5i3.2451 Original Research Significance of AST to ALT Ratio in Predicting Esophageal Varices in Cirrhotic Patients taking Esophagogastroduodenoscopy as Gold Standard Ilyas Syed Zeeshan Rasheed Faisal Younus Irfan irfanyounis7887@gmail.com * Choudhry Muhammad Afzal Tahir Furqan Qadir Adnan Aziz Bhatti Shaheed Teaching Hospital Gujrat, Islamic international Medical College Rawalpindi *Correspondence: Irfan Younus (irfanyounis7887@gmail.com) 30 08 2024 2024 5 3 615 618 16 05 2024 07 08 2024 Copyright © 2024 The Author(s) 2024 The Author(s) https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective

To determine the significance of AST to ALT ratio in predicting esophageal varices taking esophagogastroduodenoscopy (EGD) as the gold standard in cirrhotic patients

 Methodology

This six-month cross-sectional study included 193 patients. It was conducted in medical ward of DHQ Teaching Hospital, Gujrat from 11th Jul, 2021 to 11th Jan, 2022. Proper history, examination and ultrasound abdomen was done of every patient to make the diagnosis cirrhosis. LFTs and EGD was done of every patient and all data was saved. AST/ALT was calculated and endoscopic presence or absence of esophageal varices was recorded. SPSS 23was used to enter and analyze the data.

 Results

Mean age (years) was 55.68+13.69, eighty-seven (45.1%) were male and 106 (54.9%) females. There were 74 (38.3%) patients of esophageal varices who had AST/ALT ratio more than > 1.12 and 119 (61.7%) patients with less than 1.12 value. On endoscopy 89 (46.1%) patients had esophageal varices. A 2 by 2 table was utilized to determine the diagnostic accuracy, sensitivity, specificity, PPV (positive predictive value) and NPV (negative predictive value) of AST to ALT ratio in predicting esophageal varices taking EGD as gold standard which was 65.28%, 54.02%, 74.53%, 63.51% and 66.39% respectively.

 Conclusion

An effective non-invasive diagnostic tool for predicting esophageal varices in cirrhotic patients is the AST/ALT ratio

 Keywords Esophageal Varices Cirrhosis Upper GI Endoscopy AST ALT References Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases in the world. J Hepatol. 2019;70(1):151-71. Cheemerla S, Balakrishnan M. Global epidemiology of chronic liver disease. Clin Liver Dis. 2021;17(5):365. Chaabna K, Cheema S, Abraham A, Alrouh H, Lowenfels AB, Maisonneuve P, Mamtani R. Systematic overview of hepatitis C infection in the Middle East and North Africa. World J Gastroenterol. 2018;24(27):3038. Berzigotti A. Advances and challenges in cirrhosis and portal hypertension. BMC Med. 2017;15(Dec):1-8. Garbuzenko DV, Arefyev NO. Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis: An update and review of the literature. J Evid‐Based Med. 2020;13(4):313-24. Toomey DP, Hackett-Brennan M, Corrigan G, Singh C, Nessim G, Balfe P. Effective communication enhances the patients’ endoscopy experience. Irish J Med Sci. 2016;185:203-14. Garbuzenko DV, Arefyev NO. Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis: An update and review of the literature. J Evid‐Based Med. 2020;13(4):313-24. Sindhu P. A Study on Child Pugh Score as a Non Endoscopic Predictor of Oesophageal Varices in patients with Alcoholic Liver Disease (Doctoral dissertation, Madras Medical College, Chennai). Khadka D, Prajapati S, Sudhamshu KC, Shrestha JK, Karki N, Jaishi B, Regmi K, Khadka S. Significance of non-invasive markers as predictor of esophageal varices in liver cirrhosis. JNMA J Nepal Med Assoc. 2017;56(208):412-6. Alqahtani SA, Jang S. Pathophysiology and management of variceal bleeding. Drugs. 2021;81(6):647-67. Lesmana CR, Raharjo M, Gani RA. Managing liver cirrhotic complications: overview of esophageal and gastric varices. Clin Mol Hepatol. 2020;26(4):444. Brunner F, Berzigotti A, Bosch J. Prevention and treatment of variceal haemorrhage in 2017. Liver Int. 2017;37(1):104-15. Haq I, Tripathi D. Recent advances in the management of variceal bleeding. Gastroenterol Report. 2017;5(2):113-26. Jakab SS, Garcia-Tsao G. Screening and surveillance of varices in patients with cirrhosis. Clin Gastroenterol Hepatol. 2019;17(1):26-9. Moctezuma-Velázquez C, Abraldes JG. Non-invasive diagnosis of esophageal varices after Baveno VI. Turk J Gastroenterol. 2017;28(3):159-65. Nawaz K, Aziz B, Nazar T, Shabbir B. Diagnostic Accuracy of AST/ALT for Diagnosis of Esophageal Variceal Bleeding Taking Endoscopy as Gold Standard. Pak J Med Health Sci. 2015;12(2):485-8. Rye K, Scott R, Mortimore G, Lawson A, Austin A, Freeman J. Towards noninvasive detection of oesophageal varices. Int J Hepatol. 2012; 10.1155/2012/343591 Treeprasertsuk S, Kowdley KV, Luketic VA, Harrison ME, McCashland T, Befeler AS, et al. The predictors of the presence of varices in patients with primary sclerosing cholangitis. J Hepatol. 2010;51(4):1302-10.