Predictors of presence of esophageal varices in cirrhotic patients without a previous history of variceal bleeding

Abstract EN

Background : Current medical management dictates that all cirrhotic patients without a history of variceal bleeding undergo endoscopic screening for the presence of oesophageal varices (OV).

However, referral for endoscopic screening of only patients at high risk for varices may be cost-effective.

Aim of work: To identify clinical, laboratory, and ultra- sonographic parameters that predict the presence of OV in patients with liver cirrhosis.

Patients and Methods : The study included 100 patients with liver cirrhosis without a history of variceal bleeding.

A complete blood count, complete liver function tests, abdominal ultrasonography, and upper gastrointestinal endoscopy were done for all patients.

Also platelet count/ spleen diameter ratio (P/ S ratio) was calculated for all patients.

Cases defined as the presence of any oesophageal varices (OV) and controls defined as no oesophageal varices (NOV).

Logistic regression analysis was performed to evaluate association between the presence of OV and patient characteristics.

Results : The prevalence rate of OV was 76% of cirrhotic patients.

We found that platelet count, spleen diameter, P/S ratio, portal vein diameter, ascitis, serum albumin, serum bilirubin, prothrombin time and concentration, and Child-Pugh's classes were significantly different among patients with and without OV.

In a multivariate analysis, the P / S ratio was the only parameter which was independently associated with the presence of OV.

The prevalence adjusted positive and negative predictive values of P/ S ratio cut-off value ≤ 965.40 were 100% and 100% for a diagnosis of OV.

Conclusion: we found that parameters linked to portal hypertension (platelet count, spleen diameter, P/ S ratio, portal vein diameter, and ascitis) and those linked to hepatic dysfunction (serum albumin, serum bilirubin, prothrombin time and concentration, and advanced Child-Pugh's classes) were associated with the presence of OV.

Also, the P / S ratio was the only parameter independently associated with the presence of OV ; with cut-off value of ≤965.40 showed the highest accuracy for predicting the presence of OV in patients with liver cirrhosis.