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

ABSTRACT

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. To identify clinical, laboratory, and ultra-sonographic parameters that predict the presence of OV in patients with liver cirrhosis. 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 O/ and patient characteristics. 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 diagnosis of OV. 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 patients with liver cirrhosis