Prediction of oesophageal varices in patients with compensated cirrhosis: A novel scoring system

Abstract 

Background and study aims

Patients with liver cirrhosis are recommended to undergo an evaluation of oesophageal varices to assess their risk of bleeding. Predicting the presence of oesophageal varices through non-invasive means may reduce the number of unnecessary endoscopies. This study was designed to develop a predictive model for varices in patients with Child-Pugh A liver cirrhosis.

Patients and methods

Retrospective analysis was performed on 70 patients with compensated cirrhosis. Clinical and laboratory parameters Child-Pugh class and platelet count were assessed. Ultrasonographic characteristics of splenic axis and portal vein diameter were noted. The data were assessed by univariate analysis and a multivariate logistic regression analysis.

Results

We found the prevalence of oesophageal varices in patients with child A liver cirrhosis to be 64.3%. Platelet count, splenic axis, portal vein diameter, platelet count/splenic axis ratio, portal vein congestive index, and renal resistive index were found to be significantly associated with the presence of oesophageal varices on univariate analysis. A platelet count of 100,000, platelet count/splenic axis ratio <900, renal resistive index ⩾0.68, and a portal vein congestive index of ⩾0.07 had the highest discriminating value, at which the number of true positive patients was highest and the number of false positive patients was lowest (50% and 3%, 63% and 13%, 41% and 0%, 57% and 1%, respectively). Multivariate analysis identified platelet count, platelet count/splenic axis ratio, renal resistive index, portal vein congestive index as independent factors for the presence of oesophageal varices.

Conclusion

Our data suggest that a new score system composed of some laboratory and ultrasonographic parameters may predict the presence of varices in patients with Child-Pugh A cirrhosis, and that the score system may help physicians to identify patients who would most likely benefit from screenings for oesophageal varices.

Keywords: Predictors, Varices, Cirrhosis, Platelets, Non-invasive