Doppler Ultrasound Findings and Features Associated with portal hypertension in adults patients with clinically diagnosed liver cirrhosis at Moi Teaching and Referral Hospital, Eldoret, Kenya.

Abstract

Background: Liver cirrhosis is a chronic, progressive liver disease characterized by scarring of the liver and nodule formation. The most common causes are hepatitis and chronic alcoholism. It is ranked as the 14th most common cause of death worldwide. The clinical diagnosis of cirrhosis is based on a combination of clinical, biological and radiological findings. Hepatobiliary Doppler ultrasound is a valuable noninvasive and widely available tool in evaluating the hemodynamics and caliber of portal venous system and hepatic vessels. It helps in assessment of the severity of liver cirrhosis and complications such as portal hypertension allowing prompt intervention and prevention of further complications. Portal vein Congestive Index (CI) is a marker of increased portal pressures. However, there is underutilization and paucity of data on the role of Doppler ultrasound in our setup. Objectives: To describe the Doppler ultrasound findings of portal and hepatic vessels and ultrasound features associated with portal hypertension in patients with clinically diagnosed liver cirrhosis. Methods: This was a cross-sectional study conducted among adult patients with clinical diagnosis of liver cirrhosis from May 2019 to April 2020. A census sampling was used to recruit eligible participants.65 participants were studied. A data collection tool was used to record age, gender, history of alcohol consumption, jaundice, hepatitis infection titers, hepatobiliary gray scale and Doppler ultrasound findings. Mindray M7, a portable ultrasound machine with exquisite Doppler capability was used, utilizing 3.5-5 MHz curvilinear transducer (Doppler angle <60º).Continuous variables were analyzed using mean, median, and their corresponding standard deviation and interquartile ranges while categorical variables were summarized as proportions and percentages. Chi square test and Fischer's exact test were done to assess association between liver span, echogenicity and hepatofugal flow. Mann Whitney U test was done to assess the differences in the distribution of continuous variables (portal vein velocity, diameter, CI and Hepatic Artery Resistive Index) among the categorical variables (ascites, splenomegaly and hepatofugal flow). A P value of less than 0.05 was considered significant. Results: 41/65(63.1%) were male. The mean age was 47 years (SD=7.8).42/65(64.6%) had liver surface irregularities and 25/65(38.5%) had hyperechoic parenchymal echogenicity. 35/65 (53.8%) had ascites while 32/65 (49.2%) had splenomegaly. 18/65 (27.7%) had hepatofugal flow. 22/65 (33.8%) had non-triphasic hepatic vein waveform. The mean portal vein velocity, portal vein diameter, CI and Hepatic Artery Resistive Index (HARI) were 13.49 cm/s, 12.73mm, 0.13 and 0.76 respectively. Increasing HARI and CI were significantly associated with hepatofugal flow (p<0.001,<0.001), ascites (p=0.025,0.001) and splenomegaly (p=0.023,<0.001). Conclusion: Majority of the patients had liver surface irregularities with about half of the patients having increased main portal vein diameter. Increasing HARI and Congestive Index were significantly associated with presence of ascites, splenomegaly and hepatofugal flow. Recommendation: There is need for routine ultrasonography evaluation with emphasis on Doppler studies of the hemodynamic changes in patients with liver cirrhosis. Prospective studies be done to further determine the strengths of association.