Study of Non-invasive Laboratory and Imaging Predictors of Large Oesophageal Varices in Patients With Liver Cirrhosis at an Industrial Hospital in Eastern India

Introduction Oesophageal variceal bleeding, particularly from large varices, remains a major driver of morbidity and mortality in liver cirrhosis (LC), highlighting the importance of early detection of clinically significant varices. Because universal endoscopic screening may be difficult to implement in resource-limited settings, we evaluated readily available non-invasive laboratory and ultrasonographic predictors of large oesophageal varices (EV) in patients with cirrhosis. Aim This study aims to assess the utility of non-invasive laboratory and ultrasonographic parameters in predicting the severity of large EV in patients with LC treated at an industrial hospital in Eastern India. Methods We conducted a prospective observational study of newly diagnosed patients aged 15 years and older with LC at Tata Main Hospital, Jamshedpur, Jharkhand, India. We enrolled 156 patients evaluated between March 2023 and February 2025, and all participants underwent clinical assessment, laboratory testing, abdominal ultrasonography with Doppler, and upper gastrointestinal endoscopy (UGIE) for EV detection and grading. We evaluated associations between clinical, laboratory, and imaging variables and EV severity and used receiver operating characteristic (ROC) analysis to identify cut-off values for predicting large EV and performed internal validation of these cut-offs using bootstrap resampling. Results The study included 156 patients with LC with a mean age of 59.2 ± 11.0 years; most patients were 40 to 59 years old (69.2%, 83/156). The cohort included 121 men (77.6%) and 35 women (22.4%), and alcohol use was the most common aetiology (35.9%, 56/156). UGIE showed EV in 144/156 patients (92.3%) and no EV in 12/156 patients (7.7%); grade III EV was most common (49.4%, 77/156), and grade IV EV occurred in 5.1% (8/156). In multivariate ordinal logistic regression, predictors of variceal severity included Child-Turcotte-Pugh score (p < 0.0001), Model for End-Stage Liver Disease score (p = 0.003), platelet count (p < 0.0001), international normalized ratio (p = 0.002), aspartate aminotransferase-to-platelet ratio index (APRI; p < 0.0001), platelet count/spleen diameter ratio (PC/SD; p < 0.0001), portal vein (PV) diameter (p < 0.0001), and anaemia (p = 0.029). For predicting large EV, ROC analysis showed excellent discrimination for APRI (area under the curve (AUC) 0.93; cut-off > 2.11; sensitivity 89.4%; specificity 78.9%; positive predictive value (PPV) 83.5%; negative predictive value (NPV) 86.2%; diagnostic accuracy (DA) 84.6%) and PC/SD (AUC 0.93; cut-off ≤ 855; sensitivity 81.7%; specificity 91.5%; PPV 92%; NPV 80.2%; DA 85.9%). Additional predictors included aspartate aminotransferase/alanine aminotransferase ratio (AUC 0.92; cut-off > 1.2) and platelet count (AUC 0.91; cut-off ≤ 41,000). Conclusion EV were common in this high‑risk, tertiary cohort of patients with LC, and clinically significant varices were frequently identified on endoscopy. Among the non-invasive measures evaluated, the APRI and the platelet count-to-spleen diameter ratio showed the strongest overall performance for identifying patients at risk of large EV. These readily available indices, supported by ultrasonographic measures such as PV diameter, may help prioritize endoscopy for patients at high risk, particularly in settings with limited endoscopic capacity, pending external validation and threshold updating.