Indirect Predictors of Esophageal Varices in Compensated Chronic Liver Disease: A Cross-sectional Study

Background: Current guidelines recommend treating all patients with clinically significant portal hypertension (CSPH) in compensated Chronic liver disease (CLD) to prevent index decompensating event. The presence of esophageal varices is absolute evidence of CSPH. Aim of the study was to identify indirect predictors of esophageal varices in Compensated chronic liver disease. Methods: This Prospective cross-sectional study included 121 consecutive newly diagnosed compensated chronic liver disease patients. Demographic, Clinical, Biochemical, Ultrasonography Abdomen, Handgrip and Liver stiffness values were recorded. Upper gastrointestinal endoscopy was carried out to determine whether esophageal varices were present or absent. Univariate analysis and Multivariate logistic regression analysis were done to identify the predictors of esophageal varices. Results and Discussion: Of the 121 patients, (median Age 45; range 18-72 years), 92 Males (76%) with compensated chronic liver disease, 62(51.2%) had esophageal varices. On multivariate analysis, Low platelet count (Odd’s ratio [OR], 1.0; 95%CI, 1.00-1.0001) and high liver stiffness value (OR, 1.28; 95%CI, 1.12-1.46) were independent predictors of esophageal varices. Low platelets count at cutoff ≤160500/μL and high liver stiffness value at cutoff ≥14.2kPa combined had sensitivity 90.3%, specificity 88.1%, positive predictive value 88.8% and negative predictive value 89.6%. Further, Platelet to Bipolar spleen diameter (BSD) ratio had maximum Area under ROC (0.911) for predicting esophageal varices. Conclusion: Low platelet count and high liver stiffness value are independent predictors of esophageal varices in compensated chronic liver disease. By utilizing these parameters to identify low-risk patients, it may be possible to safely defer or avoid endoscopy, leading to cost savings and increased capacity within endoscopy units.