Blood Indices Replace Upper Gastrointestinal Endoscopy for the Prediction of Clinically Significant Esophageal Varices in Liver Cirrhosis

Document Type : Original Article


1 Department of General Medicine, Kodagu Institute of Medical Sciences, Kodagu, Karnataka, India

2 Department of Medical Gastroenterology, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India

3 Department of General Medicine, Bangalore Medical College and Research institute, Bangalore, Karnataka, India


Background and aim: Anticipating the existence of esophageal varices (EVs) by non-intrusive methods in cirrhotic may build consistency and limit the presentation of upper gastrointestinal endoscopy (UGIE) to those individuals with a high likelihood of having EVs. Prophecy of EVs utilizing simple blood indices and also for estimation of clinically is important large esophageal varices (LEVs).
Materials and methods: A cross-sectional experimental examination was done on 107 cirrhotic enlisted sequentially. Platelet count (PC), the ratio of aspartate aminotransferase to alanine aminotransferase (the AST/ALT ratio or AAR), AST-platelet-ratio index (APRI), Fib-4, and King's Score were determined and linked with UGIE discoveries taken as the best quality level. The execution manifested affectability, particularity, positive and negative prescient values (PPV, NPV), and area under the curve (AUC).
Results: Middle age 44 years, male (90%), and etiology-ethanol (87%). 60/107 had LEVs. For anticipating LEVs, PC at cutoff esteem < 1.5 lakhs c/mm3 exhibited affectability 66.7%; particularity 44.7%, PPV 60.6%, NPV 51.2%, and AUC 0.621. AAR for estimation of LEVs at cutoff esteem 1, showed affectability 93.3%, particularity 42.1%, PPV 54.9%, NPV 20% and AUC 0.638. Lie 4 for expectation of LEVs at cutoff esteem 3.5, showed affectability 80%, and particularity 31.9%, PPV 60%, NPV 55.6% and AUC 0.614.
Conclusion: PC, AAR, and FIB-4 had simple demonstrative precision for LEVs in cirrhosis. They recognized the subcategory that requires UGIE for the preventive administration of EVs. Generally, basic blood lists probably will not have the option to substitute the efficacy of UGIE for the finding of EVs in cirrhosis.


Main Subjects

[1]  De Franchis R, Primignani M. Natural history of portal hypertension in patients with cirrhosis. Clinics in liver disease. 2001;5(3):645-63.
[2]  Groszmann RJ, Garcia-Tsao G, Bosch J, Grace ND, Burroughs AK, Planas R, et al. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. New England Journal of Medicine. 2005;353(21):2254-61. DOI: 10.1056/NEJMoa044456.
[3]  Merli M, Nicolini G, Angeloni S, Rinaldi V, De Santis A, Merkel C, et al. Incidence and natural history of small esophageal varices in cirrhotic patients. Journal of hepatology. 2003;38(3):266-72.
[4]  Paquet KJ. Prophylactic endoscopic sclerosing treatment of the esophageal wall in varices-a prospective controlled randomized trial. Endoscopy. 1982;14(01):4-5. DOI: 10.1055/s-2007-1021560.
[5]  Wittels EG, Siegel RD, Mazur EM. Thrombocytopenia in the intensive care unit setting. Journal of Intensive Care Medicine. 1990;5(5):224-40.
[6]  Thabut D, Ratziu V, Trabut JB, Poynard T. Prediction of oesophageal varices with platelet count/spleen diameter ratio or platelets alone. Gut. 2004;53(6):913-5. 
[7]  Garcia-Tsao G, Escorsell A, Zakko M, Patch D, Matloff D, Grace N, et al. Predicting the presence of significant portal hypertension and varices in compensated cirrhotic patients. Hepatology. 1997; 26:927–30.
[8]  Pilette C, Oberti F, Aubé C, Rousselet MC, Bedossa P, Gallois Y, et al. Non-invasive diagnosis of esophageal varices in chronic liver diseases. Journal of hepatology. 1999;31(5):867-73.
[9]  Thomopoulos KC, Labropoulou-Karatza C, Mimidis KP, Katsakoulis EC, Iconomou G, Nikolopoulou VN. Non-invasive predictors of the presence of large oesophageal varices in patients with cirrhosis. Digestive and liver disease. 2003;35(7):473-8.
[10] Khuram M, Khan NY, Arif M, Irshad MM, Hammatul Bushra K, Hassan Z. Association of platelet count to splenic index ratio with presence of esophageal varices in patients with hepatitis C virus related compensated cirrhosis. Pak J Gastrenterol. 2006;20:37-42.
[11] Chalasani N, Imperiale TF, Ismail A, Sood G, Carey M, Wilcox CM, et al. Predictors of large esophageal varices in patients with cirrhosis. The American journal of gastroenterology. 1999;94(11):3285-91.
[12] Vivas S, Rodriguez M, Palacio MA, Linares A, Alonso JL, Rodrigo L. Presence of bacterial infection in bleeding cirrhotic patients is independently associated with early mortality and failure to control bleeding. Digestive diseases and sciences. 2001;46(12):2752-7.
[13] Kothari HG, Gupta SJ, Gaikwad NR, Sankalecha TH, Samarth AR. Role of non-invasive markers in prediction of esophageal varices and variceal bleeding in patients of alcoholic liver cirrhosis from central India. The Turkish Journal of Gastroenterology. 2019;30(12):1036-43. doi: 10.5152/tjg.2019.18334.
[14] Alempijevic T, Bulat V, Djuranovic S, Kovacevic N, Jesic R, Tomic D, et al. Right liver lobe/albumin ratio: contribution to non-invasive assessment of portal hypertension. World journal of gastroenterology: WJG. 2007;13(40):5331-35. doi: 10.3748/wjg.v13.i40.5331.
[15] Madhotra R, Mulcahy HE, Willner I, Reuben A. Prediction of esophageal varices in patients with cirrhosis. Journal of clinical gastroenterology. 2002;34(1):81-5.
[16] Sebastiani G, Tempesta D, Fattovich G, Castera L, Halfon P, Bourliere M, et al. Prediction of oesophageal varices in hepatic cirrhosis by simple serum non-invasive markers: Results of a multicenter, large-scale study. Journal of hepatology. 2010;53(4):630-8.
[17] Deng H, Qi X, Peng Y, Li J, Li H, Zhang Y, et al. Diagnostic accuracy of APRI, AAR, FIB-4, FI, and King scores for diagnosis of esophageal varices in liver cirrhosis: a retrospective study. Medical science monitor: international medical journal of experimental and clinical research. 2015;21:3961-77. DOI: 10.12659/msm.895005.
[18] Kraja B, Mone I, Akshija I, Koçollari A, Prifti S, Burazeri G. Predictors of esophageal varices and first variceal bleeding in liver cirrhosis patients. World journal of gastroenterology. 2017;23(26):4806-14.DOI: 10.3748/wjg.v23.i26.4806.