To explore the value of color Doppler ultrasound assessment of hepatic portal blood flow combined with liver hardness and platelet in evaluating the risk of hemorrhage in patients with esophageal and gastric varices in cirrhosis.

The clinical data of 110 cirrhotic patients with esophageal and gastric varices admitted to Shaanxi Provincial People's Hospital from March 2022 to March 2024 were retrospectively analyzed. Gastroscopy was used as the gold standard, and the patients were divided into the bleeding group (46 cases) and the non-bleeding group (64 cases) according to whether they had bleeding. All patients underwent color Doppler ultrasound. Portal vein blood flow parameters and splenic vein blood flow parameters of the two groups were recorded and compared to evaluate the hepatic portal blood flow of the patients. Liver shear wave velocity (Vs), liver elasticity test value (E), liver stiffness measurement (LSM), spleen diameter (SD) and serological indexes such as albumin (ALB), hemoglobin (Hb), total bilirubin (TBil), blood creatinine (SCr), blood urea nitrogen (SUN), activated partial thrombin time (APTT), and prothrombin time (PT) and platelet count (PLT) of all patients were collected. The LSPS score was calculated according to the ratio of LSM, PLT and SD, and the index differences between the two groups were compared. The receiver operating characteristic (ROC) curve was drawn, and the area under the curve (AUC) was calculated to evaluate the evaluation value of relevant influencing factors on the risk of hemorrhage in cirrhotic patients with esophageal and gastric varices.

DPV, QPV, DSV, QSV, LSM, SD, liver Vs and liver E in the bleeding group were higher than those in the non-bleeding group, and VPV and VSV were lower than those in the non-bleeding group, with statistically significant differences (P<0.05). The LSPS score of the bleeding group was significantly higher than that of the non-bleeding group, with statistically significant difference (P<0.05), but there were no statistically significant differences in ALB, Hb, TBil, SCr, SUN, APTT, PT and PLT between the two groups (P>0.05). Logistic multivariate regression analysis showed that DPV≥1.5 cm, VPV<10 cm/s, QPV≥1 390 mL/min, DSV≥1.4 cm, VSV<14 cm/s, QSV≥970 mL/min, LSPS≥3.9 points, liver Vs≥2.5 m/s, liver E≥15.8 kPa were independent risk factors for hemorrhage in cirrhotic patients with esophageal and gastric varices (P<0.05). ROC curve showed that the AUC in combination with DPV, VPV, QPV, DSV, VSV, QSV, LSPS, liver Vs, and liver E was 0.875 (95% CI: 0.860-0.902), and the specificity and sensitivity were 84.26% and 83.86%, respectively. The ultrasonic feature model was established based on the results of ultrasound examination (including color Doppler ultrasound and ultrasonic elastography), and the clinical model was constructed based on the LSPS score, the combined diagnostic efficiency of the two models was higher, with an AUC of 0.912 (95% CI: 0.905-0.952), which was significantly higher than that of single clinical model (LSPS) and single ultrasonic characteristic model.

Color Doppler ultrasound can help to predict the bleeding risk of patients with cirrhotic esophageal and gastric varices by measuring the blood flow dynamics of portal vein and splenic vein, and has higher prediction value in combination with liver hardness and platelet.