Noninvasive predictors of presence and grade of esophageal varices in viral cirrhotic patients

Abstract

Predicting the presence and the grade of varices by non-invasive methods is likely to predict the need for prophylactic beta blockers or endoscopic variceal ligation. The factors related to the presence of varices are not well-defined. Therefore, the present study has been undertaken to determine the appropriateness of the various factors in predicting the existence and also the grade of esophageal varices. Patients with diagnosis of liver cirrhosis due to hepatitis C or B were included in a retrospective study between January 2001 and January 2010. All the patients underwent detailed clinical evaluation, appropriate investigations, imaging studies (ultrasound with Doppler) and endoscopy at our center. Five variables considered relevant to the presence and grade of varices were tested using univariate and multivariate analysis (logistic regression). Three hundred and seventy two patients with viral liver cirrhosis were included, with 192 (51.6%) males. Platelet count and abundance of ascites were significantly associated with the presence of esophageal varices. However, abundance of ascites, prothrombin time, diameter of the spleen and portal vein were significantly associated with a large varice. In multivariate analysis, platelet count inferior to 100000 was associated with presence of varices (p = 0.04) and only abundance of ascites was associated with large varice. Low Platelet count (< or equal 100000) is associated with the presence of varices in viral cirrhotic patients and abundance of ascites is correlated with the presence of large varices.

The magnitude and correlates of esophageal Varices among newly diagnosed cirrhotic patients undergoing screening fibre optic endoscope before incident bleeding in North-Western Tanzania; a cross-sectional study

“…Contrary to our finding several other studies have reported an independent association of thrombocytopenia with presence of esophageal varices among cirrhotic patients including an earlier study by Madhora and colleague from the USA in 2002 [13], but also reported a study by Cherian et al from India [17] and Nada, et al from Morocco [19]. Thrombocytopenia has been attributed to thrombopoietin deficiency in advanced liver disease and possible increased destruction of platelets due to hypersplenism among other mechanisms [31].…”

Evaluation of INR Elevation in Cirrhotic Patients as a Risk Factor for Esophageal Variceal Bleeding

“…This result is similar to that of Pe˜naloza-Posada et al[15]. Also, other researchers studied noninvasive markers for prediction of varices and found that the increase of portal vein diameter is associated with presence of varices[22,30,31] and with large varices[19].Also, it revealed that Child Pugh score was a negative predictor of bleeding esophageal varices. This is inconsistent with Sedrak et al[20] andCherian et al [31] who reported that large varices and bleeding varices were associated with higher Child scores.…”

Are non invasive predictors of esophageal varices reliable?

“…In multivariate analysis, only grade of ascites was associated with large size varices. 5 Similarly, in another study, a significant correlation was found between platelet count and esophageal varices. 70% (28/40) patients with esophageal varices had platelet count <1,00,000/cu mm, while 80% (8/10) of patients without esophageal varices had platelet count above 1,00,000 cu mm.…”

“…In concordance with other studies no significant correlation was noted between portal vein diameter and the presence and severity of varices. 5,6 Similarly, Prothrombin time, serum bilirubin and liver enzymes like ALT, AST, ALP failed to show any significant correlation with size and presence of esophageal varices.…”