Hubungan antara Ukuran Besar Varises Esofagus secara Endoskopi dengan King Score pada Penderita Sirosis Hati

Abstract

Background : Esophageal varices was a complication that often appear in liver cirrhotic patients due to portal hypertension. Based on liver fibrosis that has role in increasing intrahepatic pressure and induce portal hypertension, therefore non-invasive liver fibrosis marker has tested as a predictor of esophageal varices in liver cirrhotic patients and was expected to be an alternative to endoscopic examination. Aim : To evaluate correlation between King Score and size of esophageal varices according to endoscopic in liver cirrhotic patients. Methods : On this analytic cross sectional study, 76 liver cirrhotic patients were enrolled. The demographics and clinical data were recorded, laboratory tests were performed (platelet count, AST, INR) so King score could calculated, and patients undergoing esophagogastroduodenoscopy (EGD). Correlation between King Score and size of esophageal varices according to endoscopic were tested by Spearman correlation analysis. Cut-off value of King score determined with Receiver Operating Characteristic (ROC) analysis and then assessed the diagnostic performance. Results : On endoscopic examination, 60 patients (78,9%) have large esophageal varices. The mean of King score was 74,21 +-.58,13. There are positive correlation between King Score and size of esophageal varices according to endoscopic (r =0,424; p : 0,0001). King score using cut-off value > 35,1 shows good diagnostic performance to predict large esophageal varices $ith 81,7% sensitivity, 81,3% specificity, 94,2% PPV , 54,2% NPV, 4,37 LR(+), 0,23 LR(-), accuracy diagnostic was 81,5%, and the AUROC was 0,800 (95% CI:0,633 - 0,967); p: 0,0001). Conclusion : King score is a simple non - invasive method, unexpensive, and accurate as a predictor of size of esophageal varices in liver cirrhotic patients.

Latar Belakang : Varises esofagus merupakan komplikasi yang sering muncul pada pasien sirosis hati akibat hipertensi portal. Berdasarkan konsep fibrosis hati yang berperan dalam peningkatan tekanan intrahepatik dan menyebabkan hipertensi portal, maka penanda fibrosis hati yang non - invasif diuji sebagai prediktor varises esofagus pada pasien sirosis hati dan diharapkan mampu menjadi alternatif dan pemeriksaan endoskopi. Tujuan : Untuk mengetahui hubungan antara ukuran besar varises esofagus secara endoskopi dergar King score pada penderita sirosis hati Metode : Studi potong lintang bersifat analitik dengan subjek penelitian 76 orang pasien sirosis hati. Dilakukan pencatatan data demografis dan klinis, pemeriksaan laboratorium (jumlah platelet, AST, INR) untuk mengkalkulasi nilai King score, serta menjalani tindakan esophagogastroduodenoscopy (EGD). Hubungan antara ukuran besar varises esofagus secara endoskopi dengan King score diuji dengan analisis korelasi Spearman. Nilai cut-off King Score ditentukan dengan analisis Receiver Operating Characteristic (ROC) dilanjutkan dengan uji performa diagnostik. Hasil : Dari hasil pemeriksaan endoskopi didapati 60 orang (78,9%) memiliki varises esofagus berukuran besar. Rerata nilai King score didapatkan 74,21 +- 58,13. Terdapat korelasi yang positif antara King score dengan ukuran besar varises esofagus secara endoskopi (r = 0,424; p : 0,0001). Dengan nilai cut-off > 35,7 King score menunjukkan performa diagnostik yang baik untuk memprediksi varises esofagus yang berukuran besar dengan sensitifitas 81,77o, spesifisitas 81,3%, PPV 94,2%, NPV 54,2 %, LR (+) 4,37, LR (-) 0,23, akurasi diagnostik 81,5%, dan AUROC 0,800 (95% CI:0,633 - 0,967); p :0,0001). Kesimpulan : Metode non - invasif King score sangat sederhana, murah, dan akurat sebagai prediktor ukuran besar varises esofagus pada pasien sirosis hati.