Evaluation of Some Non Invasive Predictors for Presence of Esophageal Varices in Patients with Compensated HCV Positive Cirrhosis

Background: The current guidelines recommend the screening of all cirrhotic patients by endoscopy for esophageal varices (EV), but repeated endoscopic examinations are unpleasant for patients and have a high cost impact and burden on endoscopic units. Recognition of non-invasive predictors of EV will allow upper gastrointestinal tract (GIT) endoscopy to be carried out only in a selected group of patients, thus avoid unnecessary intervention and at the same time not to miss patients at risk of bleeding. Aim: the aim of this study was to evaluate the validity of three noninvasive parameters in the prediction of esophageal varices in patients with compensated hepatitis C virus (HCV) +ve liver cirrhosis namely insulin resistance, platelet count/spleen diameter ratio and right liver lobe diameter/albumin ratio. Patients and Methods: This prospective study included one hundred non-diabetic, non-obese patients with Child A HCV induced cirrhosis. All studied patients underwent a detailed history, thorough physical examination, biochemical workup, upper gastrointestinal endoscopy and abdominal ultrasound. Insulin resistance (IR) by the homeostasis model assessment (HOMA), the platelet count/spleen diameter ratio and the right liver lobe diameter/albumin ratio for all patients were calculated. Results: The prevalence of esophageal varices in Child A HCV +ve cirrhosis were high. The three predictors demonstrated a high statistically significant correlation with the presence and grade of esophageal varices (P values < 0.001). Among the three non-invasive predictors, the HOMA-IR score gave the highest accuracy at a cut-off value of 3. The next highest accuracy was associated with the platelet count/spleen diameter ratio at a cut-off value of 750. The least accurate of the three non-invasive predictors was right liver lobe diameter /albumin ratio at a cut-off value of 3.5. Conclusion: Insulin resistance measured by HOMA-IR, Platelet count/Spleen diameter ratio, as well as the right liver lobe diameter/Albumin ratio are non-invasive parameters that can predict the presence and the grade of esophageal varices in patients with Child A HCV +ve cirrhosis and can help physicians to restrict the use of endoscopic screening only to patients presenting a high probability of esophageal varices. This is especially useful in clinical settings where resources are limited and endoscopic facilities are not present in all areas. Such the case in Egypt, where there is a large number of patients who require screening for esophageal varices.