Prediction of Esophageal Varices in Liver Cirrhosis using Noninvasive Parameters: An Observational Study

Abstract Background: Esophageal varices (EVs) are a common and serious complication of portal hypertension in cirrhosis, with bleeding leading to significant morbidity and mortality. Upper gastrointestinal endoscopy remains the gold standard for diagnosis, but it is invasive, expensive, and resource-intensive. Noninvasive predictors can help prioritize patients for screening. Aims and Objectives: To assess clinical, biochemical, and radiological noninvasive parameters in predicting the presence and severity of EVs and to determine the most accurate predictor of high-risk varices in cirrhotic patients. Materials and Methods: This hospital-based, cross-sectional study included 100 adults with confirmed liver cirrhosis. All participants underwent upper gastro intestinal endoscopy and variceal grading according to Paquet’s classification. Eight parameters—Child-Pugh class, platelet count, spleen diameter, portal vein diameter (PVD), the platelet count-to-spleen diameter (PC/SD) ratio, aspartate aminotransferase/alanine aminotransferase ratio, APRI, and FIB-4 index—were analyzed for their association with (1) presence versus absence of varices, (2) variceal Grades 0–4, and (3) high-risk (Grades 3–4) versus low-risk (Grades 0–2) varices. Statistical tools included the Mann–Whitney U test, Spearman correlation, and receiver operating characteristic analysis. Results: Varices were present in 87% of patients. Significant predictors were low platelet count ( P < 0.0001), larger spleen size ( P < 0.0001), low PC/SD ratio ( P < 0.0001), higher Child-Pugh score ( P = 0.0010), and increased PVD ( P = 0.0001). Variceal grade correlated positively with Child-Pugh score ( r = 0.73), spleen size ( r = 0.51), and portal vein size ( r = 0.43), and negatively with PC/SD ratio ( r = −0.65). The best predictor for high-risk varices was Child-Pugh class C (area under the curve [AUC] = 0.866), followed by a spleen size of ≥15.7 cm (AUC: 0.864), a PC/SD ratio of