Evaluation of serum kallistatin level as a predictor of esophageal varices in cirrhotic patients

Figures & data

Table 1. Comparison of demographic, clinical, and sonographic data in the studied groups

		Group I No=35	Group II No=35	Test	p-value
Age (years) (mean ±SD)		49.3 ± 4.3	48.9 ± 3.1	T= 0.477	0.635 (NS)
Gender No (%)	Males	18 (51.4%)	22 (62.9%)	X^2= 0.933	0.334 (NS)
	Female	17 (48.6%)	13 (37.1%)
Viral markers	HBV	4 (11.4%)	2 (5.7%)	X^2= 0.731	0.694 (NS)
	HCV	30 (85.7%)	32 (91.4%)
	Both	1 (2.9%)	1 (2.9%)
History of bilharziasis		6 (17.1%)	6 (17.1%)	X^2 =1	1.00 (NS)
Hepatomegaly		13 (37.1%)	12 (34.3%)	0.062	0.803 (NS)
Ascites	No ascites	25 (71.4%)	29 (82.9%)	5.387	0.146 (NS)
	Mild	5 (14.3%)	6 (17.1%)
	Moderate	3 (8.6%)	0 (%)
	Tense	2 (5.7%)	0 (%)
Lower limb edema		8 (22.9%)	6 (17.1%)	0.357	0.55 (NS)
Encephalopathy		4 (11.4%)	0 (%)	4.242 ^₣	0.114(NS)
Child's grade No (%)	A	15 (42.9%)	29 (82.9%)	X^2= 13.312	0.001 (S)
	B	15 (42.9%)	6 (17.1%)
	C	5 (14.3%)	0 (0%)
Child's score (points)		7.17 ± 1.96	5.54 ± 0.78	Z=-4.34	<0.001 (HS)
Portal vein diameter (mm)		14.5 ± 1.2	11.8 ± 0.9	Z=-6.968	<0.001 (HS)
Spleen diameter (cm)		20.1 ± 1.9	18.6 ± 1.5	T=3.523	0.001 (S)

SD, standard deviation; NS, non-significant; HS, highly significant; S, significant; ^₣, fisher exact; Z, Mann–Whitney test; T, student test; X², chi-square.

Table 2. Comparison of laboratory parameters in the studied groups

	Group I No = 35	Group II No = 35	test	p-value (sig.)
Hemoglobin(g/dl)	12.2 ± 0.9	12.4 ± 1.1	T = −1.102	0.274 (NS)
WBC’s(x10^3/ml)	5.7 ± 1.4	6.2 ± 2.1	T = −1.232	0.222 (NS)
Platelet count (x10^3/ml)	105.4 ± 25.3	145.3 ± 32.3	T = −5.749	<0.001 (HS)
Bilirubin (mg/dl)	1.77 ± 0.71	1.38 ± 0.36	Z = −1.898	0.058 (NS)
Albumin(g/dl)	3.16 ± 0.36	3.62 ± 0.33	T = −5.699	<0.001 (HS)
ALT(IU/L)	44.5 ± 13.7	41.6 ± 14.2	Z = −1.129	0.259 (NS)
AST(IU/L)	49.5 ± 15	46.0 ± 12.2	Z = −1.005	0.315 (NS)
INR	1.49 ± 0.28	1.22 ± 0.18	Z = −4.598	<0.001 (HS)
Urea(mg/dl)	20.0 ± 4.1	22.5 ± 9.9	Z = −0.124	0.901 (NS)
Creatinine (mg/dl)	0.98 ± 0.19	0.91 ± 0.18	Z = −1.453	0.146 (NS)
Kallistatin (µg/ml)	12.21 ± 5.65	16.99 ± 4.87	Z = −2.596	0.009 (S)
Median	14.9	15.9
Range	1.8–17.8	10.3–32.5

WBCs, white blood cells; ALT, alanine transaminase; AST, aspartate transaminase; PT, prothrombin time; INR, international normalizing ratio; T, student test; Z, Mann–Whitney test; SD, standard deviation; NS, non-significant; HS, highly significant; S, significant.

Table 3. Comparison of kallistatin level in different child, esophageal varices, and portal hypertensive gastropathy grades in both groups

		Kallistatin level Mean ±SD	Kruskal–Wallis test	P
Child’s grade	A	15.53 ± 4.07	11.676	0.003 (S)
	B	15.1 ± 6.75
	C	4.35 ± 4.95
Esophageal varices	0	16.99 ± 4.87	18.745	0.002 (S)
	I	13.46 ± 3.99
	II	14.44 ± 4.22
	III	16.43 ± 1.35
	IV	8.93 ± 6.45
	Gastric	2.25 ± 0.18
PHG	Non	15.92 ± 3.98	10.276	0.016 (S)
	I	16.62 ± 6.65
	II	14.69 ± 4.27
	III	8.48 ± 6.7

PHG, portal hypertensive gastropathy; SD, standard deviation; S, significant.

Table 4. Correlation between kallistatin level and different patients’ parameters in the studied population

Variables	Kallistatin
	R	P-Value
Bilirubin	−0.11	0.3(NS)
Albumin	0.11	0.3(NS)
WBC’s	0.24	0.04(S)
Hemoglobin	0.25	0.03(S)
Platelet count	0.09	0.4(NS)
Creatinine	−0.27	0.019(S)
INR	−0.28	0.15(S)
PVD	−0.23	0.049(S)
Spleen size	−0.18	0.13(NS)
EV grade	−0.283	0.02 (S)
Child score	−0.478	0.002 (S)

WBCs: white blood cells, INR: international normalizing ration, PVD: portal vein diameter, EV: esophageal varices, S: significant, NS: non-significant.

Table 5. Multivariate regression analysis of significant independent predictors of presence of esophageal varices

variables	coefficient	SE	P
INR	0.00710849	0.638871	0.99(NS)
Platelet count	−0.00316456	0.00469364	0.5(NS)
Kallistatin level	−0.0141504	0.00702236	0.048 (S)
Child’s score	0.0567011	0.115648	0.62(NS)
PVD	0.583626	0.116040	<0.001(HS)
Spleen size	0.0567011	0.115648	0.82(NS)

r² = 0.681.

ANOVA < 0.001.

Albumin was excluded from the model,

PVD: portal vein diameter, INR: international normalizing ratio, WBCs: white blood cells, S: significant, NS: non-significant.

Table 6. Clinical performance of the kallistatin as predictor of the presence of EV, large EV, PHG, and severe PHG

	Cutoff value(µg/ml)	AUC	Sensitivity (%)	Specificity (%)	Accuracy (%)	PPV (%)	NPV (%)	p-value
EV	≤ 15.8	0.68	71.4	54.3	62.9	61	65.5	0.009(S)
Large EV	≤ 8.9	0.712	50	94.6	85.7	70	88.3	0.015(S)
PHG	≤ 15.4	0.587	60	62.9	61.4	61.8	61.1	0.21(NS)
Severe PHG	≤ 8.9	0.794	58.3	94.8	88.6	70	91.7	.001(HS)

AUC, area under curve; PPV, positive predictive value; NPV, negative predictive value; EV, esophageal varices; PHG, portal hypertensive gastropathy; NS, non-significant; HS, highly significant; S, significant.