Dekompanse Siroz Hastalarında Özofagus Varis Varlığı ile Periostin Düzeyleri Arasındaki İlişki

Year 2024, Volume: 11 Issue: 2, 88 - 96, 31.08.2024

Çağdaş Kunt , Korhan Kollu , Fatma Büşra Çakır Kunt , Barış Can Ünal , Gökhan Güngör , Muhammet Cemal Kızılarslanoğlu , İbrahim Güney

https://doi.org/10.47572/muskutd.1429164

Abstract

Özofagus varisleri, dekompanse karaciğer sirozu hastalarında hastalığın şiddeti ile ilişkili olarak ortaya çıkan ve hayatı tehdit eden bir komplikasyondur. Bu çalışmada, dekompanse siroz hastalarında özofagus varis gelişimi ile serum periostin düzeyi arasında ilişki olup olmadığı incelenecektir. Dekompanse karaciğer sirozu tanısı olan ve üst GIS endoskopisi yapılan 18-70 yaş aralığındaki hastalar bu çalışmaya dâhil edildi. Hastaların serum periostin düzeyi ile özofagus varis gelişimi arasındaki ilişki incelendi. Özofagus varisi olan hastalar, varis evrelerine göre evre I, II ve III şeklinde üç gruba ayrılıp grupların periostin seviyeleri karşılaştırıldı. Hastaların 43’ü (%54.4) kadın, 36’sı (%45.6) erkekti ve yaş medyan değeri 62 (20-70) olarak hesaplandı. Hastaların 60’ında (%75.9) özofagus varisi mevcuttu (evre I; n=16, evre II; n=23, evre III; n=21). Özofagus varisi olan grubun serum periostin düzeyi, varisi olmayan gruba nazaran daha yüksekti ancak fark istatistiksel olarak anlamlı düzeyde değildi (p=0.222). Özofagus varisi olan hastalar varis evrelerine göre karşılaştırıldığında, gruplar arasında periostin seviyeleri açısından anlamlı fark yoktu (p=0.480). Korelasyon analizinde, periostin ile CHILD skoru (r=0.307, p=0.006), GPR (r=0.279, p=0.013), APRI (r=0.283, p=0.011), FIB-4 skoru (r=0.286, p=0.011) ve INR değeri (r=0.235, p=0.037) arasında pozitif korelasyon, P2/MS skoru (r=-0.275, p=0.014), trombosit (r=-0.282, p=0.012) ve albumin (r=0.356, p=0.001) arasında negatif korelasyon tespit edildi. Serum periostin düzeyi ile özofagus varisi varlığı ve varis evreleri arasında anlamlı ilişki bulunamadı. Periostin ile birçok prognostik belirteç arasında korelasyon bulunması, periostinin siroz hastalarında potansiyel bir prognostik belirteç olabileceğini düşündürdü.

Keywords

Dekompanse Karaciğer Sirozu, Fibrozis, Özofagus Varisi, Periostin

The Relationship between Periostin Level and the Presence of Esophageal Varices in Patients with Decompensated Cirrhosis

Abstract

Esophageal varices are life-threatening complications of decompensated liver cirrhosis. Herein, it was aimed to explore the relationship between esophageal varices and serum periostin levels in decompensated cirrhosis patients. Decompensated liver cirrhosis patients (18-70 years) undergoing upper gastrointestinal (GIS) endoscopy were included in the study. The relationship between serum periostin and esophageal varices was investigated. Those with esophageal varices were divided into three groups: stages I, II, and III, and the periostin levels of the groups were compared. Forty-three (54.4%) patients were female, and the median age was 62 years (20-70 years). Sixty (75.9%) patients had esophageal varices (stage I, n=16; stage II, n=23; stage III, n=21). Although serum periostin level was higher in those with esophageal varices than those without, the difference was not statistically significant (p=0.222). Given the grades of esophageal varices, no significant difference was seen between the groups concerning periostin levels (p=0.480). In analyses, statistically significant positive correlations were found between periostin levels and Child-Pugh score (r=0.307, p=0.006), gamma-glutamyl transpeptidase to platelet ratio (GPR) (r=0.279, p=0.013), aminotransferase (AST)/platelet ratio index (APRI) (r=0.283, p=0.011), fibrosis-4 (FIB-4) score (r=0.286 p=0.011), and international normalized ratio (INR) value (r=0.235, p=0.037), and negative correlations between periostin levels and P2/MS scores (r=-0.275, p=0.014), platelet (r=-0.282, p=0.012) and albumin (r=0.356, p=0.001). There was no significant relationship between serum periostin levels and the presence and grade of esophageal varices. The correlation between periostin and other prognostic markers suggested that periostin might be a potential prognostic marker in cirrhosis patients.

Keywords

Decompensated Liver Cirrhosis, Fibrosis, Esophageal Varices, Periostin

References

• 1. Garcia-Tsao G, Abraldes JG, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology. 2017;65:310-35.
• 2. Conway SJ, Izuhara K, Kudo Y, et al. The role of periostin in tissue remodeling across health and disease. Cell Mol Life Sci. 2014;71,1279-88.
• 3. Jia Y, Zhong F, Jiang S, et al. Periostin in chronic liver diseases: Current research and future perspectives. Life Sci. 2019;226:91-7.
• 4. Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60:646-9.
• 5. Malinchoc M, Kamath PS, Gordon FD, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000;31:864-71.
• 6. Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359:18-1026.
• 7. Sheth SG, Flamm SL, Gordon FD, et al. AST/ALT ratio predicts cirrhosis in patients with chronic hepatitis C virus infection. Am J Gastroenterol. 1998;93:44-8.
• 8. Imperiale TF, Said AT, Cummings OW, et al. Need for validation of clinical decision aids: use of the AST/ALT ratio in predicting cirrhosis in chronic hepatitis C. Am J Gastroenterol. 2000;95:2328-32.
• 9. Lee JH, Yoon JH, Lee CH, et al. Complete blood count reflects the degree of oesophageal varices and liver fibrosis in virus-related chronic liver disease patients. J Viral Hepat. 2009;16:444-52.
• 10. Forns X, Ampurdanes S, Llovet JM, et al. Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model. Hepatology. 2002;36:986-92.
• 11. Lemoine M, Shimakawa Y, Nayagam S, et al. The gamma-glutamyl transpeptidase to platelet ratio (GPR) predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa. Gut. 2016;65:1369-76.
• 12. Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38:518-26.
• 13. Lin ZH, Xin YN, Dong QJ, et al. Performance of the aspartate aminotransferase-to-platelet ratio index for the staging of hepatitis C-related fibrosis: an updated meta-analysis. Hepatology. 2011;53:726-36.
• 14. Biyik M, Ucar R, Solak Y, et al. Blood neutrophil-to-lymphocyte ratio independently predicts survival in patients with liver cirrhosis. Eur J Gastroenterol Hepatol. 2013;25:435-41.
• 15. Sterling RK, Lissen E, Clumeck N, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006;43:1317-25.
• 16. McPherson S, Hardy T, Dufour JF, et al. Age as a confounding factor for the accurate non-invasive diagnosis of advanced NAFLD fibrosis. Am J Gastroenterol. 2017;112:740-51.
• 17. Angulo P, Bugianesi E, Bjornsson ES, et al. Simple noninvasive systems predict long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. 2013;145:782-9.
• 18. Huang Y, Liu W, Xiao H, et al. Matricellular protein periostin contributes to hepatic inflammation and fibrosis. Am J Pathol. 2015;185:786-97.
• 19. Lv Y, Wang W, Jia WD, et al. High preoperative levels of serum periostin are associated with poor prognosis in patients with hepatocellular carcinoma after hepatectomy. Eur J Surg Oncol. 2013;39:1129-35.
• 20. Merli M, Nicolini G, Angeloni S, et al. Incidence and natural history of small esophageal varices in cirrhotic patients. J Hepatol. 2003;38:266-72.
• 21. Groszmann RJ, Garcia-Tsao G, Bosch J, et al. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med. 2005;353:2254-61.
• 22. D'Amico G, Pagliaro L, Bosch J. The treatment of portal hypertension: a meta-analytic review. Hepatology. 1995;22:332-54.
• 23. Reiberger T, Bucsics T, Paternostro R, et al. Small esophageal varices in patients with cirrhosis-should we treat them? Curr Hepatol Rep. 2018;17:301-15.
• 24. Jalan R, Hayes PC. UK guidelines on the management of variceal hemorrhage in cirrhotic patients. British Society of Gastroenterology. Gut. 2000;46(Suppl III):iii1–15.
• 25. Tetsuo T, Ryotaro S. Remaining challenges for the noninvasive diagnosis of esophageal varices in liver cirrhosis. Esophagus. 2020;17:19-24.
• 26. Thomopoulos KC, Labropoulou-Karatza C, Mimidis KP, et al. Non-invasive predictors of the presence of large oesophageal varices in patients with cirrhosis. Dig Liver Dis. 2003;35(7):473-8.
• 27. Sarangapani A, Shanmugam C, Kalyanasundaram M, et al. Noninvasive prediction of large esophageal varices in chronic liver disease patients. Saudi J Gastroenterol. 2010;16:38-42.
• 28. Zhang F, Liu T, Gao P, et al. Predictive value of a noninvasive serological hepatic fibrosis scoring system in cirrhosis combined with oesophageal varices. Can J Gastroenterol Hepatol. 2018;2018:7671508.
• 29. Deng H, Qi X, Guo X. Diagnostic accuracy of APRI, AAR, FIB-4, FI, King, Lok, Forns, and FibroIndex Scores in predicting the presence of esophageal varices in liver cirrhosis: a systematic review and meta-analysis. Medicine. 2015;94:e1795.
• 30. Kim BK, Han KH, Park JY, et al. Prospective validation of P2/MS noninvasive index using complete blood counts for detecting oesophageal varices in B-viral cirrhosis. Liver Int. 2010;30:860-6.