Use of Non-invasive markers in Predicting the Severity of Esophageal Varices in Liver cirrhosis: A Hospital Based Descriptive Observational Study

Abstract

Introduction: Esophageal varices in patients with cirrhosis have serious clinical consequences. Though invasive, endoscopy is the gold standard for screening varices. Noninvasive tests are used to reduce the unnecessary endoscopies. The aim of the study was to assess the noninvasive markers of esophageal varices in cirrhotic patients.

Methods: This descriptive study analyzed eligible cirrhotic from January to June 2019. Clinical and laboratory parameters were assessed to grade the high risk varices according to severity of cirrhosis. Liver stiffness was measured by fibroscan and shear wave elastography. Analysis of these parameters was done to predict severity of esophageal varices.

Results: Seventy five patients were included, where the incidence of large and high-risk esophageal varices were 69% and 77% respectively. Independent predictors of large varices were splenic diameter >120 mm, portal vein diameter >13 mm, transient elastography ≥20 kPa and platelet count spleen diameter ≤909. The predictors for high-risk varices were shear wave elastography ≥22 kPa, platelet count spleen diameter ≤909 and liver stiffness-spleen size-to-platelet ratio risk score >2.2. The sensitivity, specificity, positive predictive value and negative predictive value for prediction of large varices were similar.

Conclusion: Strong noninvasive predictors were spleen size, portal vein diameter, transient elastography, platelet count spleen diameter ratio for large varices and shear wave elastography, platelet count spleen diameter ratio and liver stiffnessspleen size-to-platelet ratio risk score for high-risk varices. These parameters can be used to avoid unnecessary endoscopy and in resource limited settings.