DUPLEX DOPPLER EVALUATION OF PORTAL HYPERTENSION IN CIRRHOTIC PATIENTS AND ITS CORRELATION WITH CHILD-PUGH SCORE

Abstract

Background: Portal hypertension is a major consequence of cirrhosis and is associated with progressive changes in portal and hepatic venous hemodynamics. Although hepatic venous pressure gradient measurement is the reference standard, its invasive nature limits routine use. Duplex Doppler ultrasonography offers a non-invasive method for assessing portal flow, hepatic venous waveform characteristics and derived vascular indices. Objective: To evaluate portal hypertension on duplex Doppler in cirrhotic patients and assess its correlation with Child Pugh class, with additional evaluation of Doppler indices for prediction of esophageal varices. Materials and methods: This cross-sectional study included 93 adults with cirrhosis evaluated over 18 months at Teerthanker Mahaveer Medical College and Research Centre. Ultrasonography and Doppler examinations were performed on a Siemens ACUSON S2000/S3000 system using a 6C1 HD convex transducer. Portal vein velocity and flow direction, hepatic venous waveform and hepatic venous damping index (HVDI), splenic index, splenoportal index (SPI), portal congestion index (PCI), ascites and portosystemic collaterals were assessed and correlated with Child-Pugh class. Statistical analysis included correlation, one-way ANOVA, group comparison, ROC analysis and logistic regression. Results: Mean age was 52.34 ± 15.16 years and 78.5% of patients were male. Child-Pugh class A, B and C accounted for 51.6%, 30.1% and 18.3% of the cohort, respectively. Portal vein velocity correlated negatively with Child-Pugh class (r = -0.254, p = 0.014), whereas HVD and PCI  correlated positively (all p < 0.001). Esophageal varices were identified in 17 patients. On multivariate analysis, HVDI (adjusted OR 49.16) and SPI (adjusted OR 1.375) remained independent predictors of varices. Conclusion: Duplex Doppler parameters demonstrate progressive hemodynamic deterioration with increasing Child-Pugh severity. HVDI, SPI and PCI are useful non-invasive markers, while HVDI and SPI may help identify cirrhotic patients at increased risk of esophageal varices.