Non-Invasive Predictors of Esophageal Varices in Cirrhosis Patients

Abstract

Introduction: Esophageal varices develop in cirrhotic patients at an annual rate of 8%.Current guidelines suggest screening for varices in cirrhotics, once the diagnosis of liver cirrhosis is made and then surveillance every 1-3 years.In certain circumstances,therapeutic decisions will have to be made without the use or while awaiting the use of an invasive procedure like esophagogastroduodenoscopy(EGD). Therefore, identifying a non-invasive modality to indicate or predict the presence of esophageal varices may lead to improved management. Methods: This is a retrospective observational study conducted on patients with cirrhosis.Data regarding demographic, endoscopic and laboratory findings were reviewed and subjects with incomplete data were excluded.The correlation of presence of proven varices and biochemical markers, spleen and liver diameters were analyzed using SAS statistical software. Results: 77 subjects constituted our cohort of cirrhosis and 67 subjects had proven esophageal varices. In this group, 27 had large varices and 14 had high risk stigmata of bleeding including the red wale sign. The mean age of the subjects was 64 years and 56% (43/77) were male. 84% (65/77) of the cohort were African American and Hispanics.Etiology of cirrhosis included Hepatitis C (35%), alcohol (25%), Nonalcoholic steatohepatitis (3%), cardiac (9%) and cryptogenic (25%). On statistical analysis, high AST to Platelet ratio index (APRI) score were significantly associated with presence of esophageal varices (3.15 ± 3.22 vs 1.76 ± 2.89, P value < 0.001).AST level and platelet count by themselves did not show significant association with the presence of varices (P value= 0.8 and 0.9 respectively).Low Albumin level was significantly associated with the presence of esophageal varices (2.88 ± 1.41 vs 3.12 ± 1.31, P value < 0.001). The association between the presence of esophageal varices and other biochemical markers such as prothrombin time,partial thromboplastin time,international normalized ratio,splenic and liver diameters on ultra-sonography were not statistically significant. Conclusion: In certain circumstances, therapeutic decisions will have to be made without the use or while awaiting an invasive diagnostic tool like EGD.This study suggests that cirrhotics with a high APRI score and low albumin level show significant association with the presence of esophageal varices.These two markers appear to be independent predictors.