Identification of Potential Metabolic Biomarkers in Predicting Esophageal Varices Needing Treatment in Patients With Liver Cirrhosis

Abstract Background: The goal of this study was to determine the diagnostic performance of in vivo quantitative proton magnetic resonance spectroscopy (1H-MRS) to identify the presence of esophageal varices needing treatment (VNT), as well as to investigate its correlation with clinical variables in patients with liver cirrhosis. Methods: Forty cirrhotic patients without VNT showing negative red color sign, and 40 cirrhotic patients with VNT showing positive red color sign underwent laboratory tests, esophago-gastro-duodenoscopy, and 1H-MRS with single-voxel localization in cirrhotic liver parenchyma. Results: The levels of lactate+triglyceride (TG) and choline in cirrhotic patients with VNT were significantly higher than those of cirrhotic patients without VNT. Lactate+TG and choline levels were positively correlated with spleen diameter and negatively correlated with platelet count in the combined group of cirrhotic patients with and without VNT. In cirrhotic patients with VNT, older age, longer spleen diameter, lower platelet counts, and lower ratios of platelet count/spleen diameter were independently associated with an increase of lactate+TG and choline metabolites in the presence of esophageal VNT. Additionally, the area under the curve used to distinguish cirrhotic liver with VNT from cirrhotic liver without VNT was 1.00 (95% confidence interval [CI]: 0.95–1.00) for lactate+TG and 0.67 (95% CI 0.55–0.77) for choline. Conclusions: Our study demonstrated that higher hepatic lactate+TG and choline levels in cirrhotic patients in conjunction with longer spleen diameter, lower platelet counts, and lower ratios of platelet count to spleen diameter were associated with the presence of esophageal VNT and the risk of developing variceal bleeding. Therefore, in vivo, 1H-MRS may be an effective tool for diagnosing and predicting esophageal VNT in patients with liver cirrhosis.