Noninvasive assessment of the presence and size of esophageal varices

Introduction/Aim. A significant number of patients with liver cirrhosis who underwent screening endoscopy do not have esophageal varices (EV) or have varices that do not require prophylactic therapy. Given the invasiveness of the procedure, the need to develop non-endoscopic methods in predicting the presence of EV is reasonable. The aim of the study was to determine the significance of clinical, biochemical and ultrasonic parameters in the prediction of EV. Methods. The study included 59 patients with cirrhosis of the liver, 39 (66.1%) patients with EV and 20 (33.9%) patients without EV. In the group of patients with EV, 22 (56.4%) patients had small EV and 17 (46.3%) patients had large EV. Clinical parameters that included Child Pough (CP) score, ascites, and splenomegaly were evaluated. In all participants, complete blood count, liver function tests, abdominal ultrasound and gastroscopy were performed, and a platelet count/spleen diameter ratio (PC/SD) was calculated. Results. Univariate logistic regression analysis showed that independent risk factors for the occurrence of EV were: CP B class (OR 6.67, p=0.003) and CP C class (OR 23.33, p=0.005) relative to class A, ascites (OR 7.78, p =0.001), spleen size (OR 1.035, p =0.016), bilirubin (OR 1.065, p=0.007), albumin (OR 0.794, p =0.001), protrombin time (PT) (OR 0.912, p<0.001), INR (OR 231.364, p <0.001), platelet count? Plc (OR 0.989, p =0.023), PC/SD ratio (OR0.999, p=0.034). In a multivariate model, it was shown that a decreased Plc was a statistically significant risk factor for the presence of EV (OR 0.983, p =0.023). Leukopenia and the size of the right liver lobe were found to be statistically significant factors for the occurrence of large EV. Based on the ROC curve for the PC/SD ratio, the cut-off value of the test was obtained - 907 (907.11), with a negative predictive value of 76.4% for large EV. Conclusion. The cut-off value of PC/SD < 907 has a predictive value for the occurrence of large EV.