984 Non-Invasive Predictors of Moderate-Large Esophageal Varices in Compensated Cirrhotic Patients

Abstract

INTRODUCTION: Esophageal variceal hemorrhage (EVH) is a severe complication of liver cirrhosis with a high mortality rate. Esophagogastroduodenoscopy (EGD) screening to detect esophageal varices (EV) is currently recommended for all newly diagnosed cirrhotic patients. However, many patients who undergo EGD do not have varices, especially in compensated cirrhotic patients. Furthermore, EGD is an expensive and invasive procedure. The aim of the study is to identify a non-invasive and low-cost scoring system that could predict the presence of moderate–large EV in compensated cirrhotic patients. METHODS: A cross-sectional study was conducted in newly diagnosed patients with non-Child-Pugh (CP) C liver cirrhosis, without a history of variceal bleeding. Demographic, clinical, biochemical, and ultrasonographic parameters will be recorded. Presence and degree of esophageal varices will be determined during EGD. In order to identify independent predictors for the presence of esophageal varices, univariate and multivariate logistic regression will be analyzed. RESULTS: EV was found in 47 from 80 patients (58.8%) that were enrolled in this study. Of 47 patients, moderate-large varices was detected in 20/34 (58.8%) and 12/13 (92.3%) patients with CP-A and CP-B class, respectively. In univariate analysis, low platelet count (≤100 000/μL), increased bipolar spleen diameter (≥135 mm), and platelet count/bipolar spleen diameter ratio ≤ 847 were associated with the presence of moderate-large EV. Only platelet count/bipolar spleen diameter ratio was associated in multivariate analysis. The AUC, sensitivity and specificity of platelet count/bipolar spleen diameter ratio ≤ 847 is 0.77, 90.6% and 58.3%, respectively. CONCLUSION: Low platelet count is commonly found in liver cirrhotic patients and easily obtained in resource-limited setting. The enlarged spleen is often observed in patients with liver cirrhosis and associated with a higher risk of complications. The ratio of low platelet count/spleen bipolar diameter has been used to predict the presence of EV in cirrhotic patients, however, the previous studies included the patients with compensated and decompensated cirrhosis. For the implementation in daily clinical practice with resource-limited setting, a patient with compensated liver cirrhosis and platelet count/bipolar spleen diameter ratio ≤ 847 is highly recommended to undergo EGD screening procedure.