Prediction of large esophageal varices among patients with liver cirrhosis in Sanglah Hospital Denpasar

Objective: Findings of liver cirrhosis are usually accompanied with screening endoscopy for large esophageal varices (EV) that may benefit from prophylactic measures. The aim of this study was to identify whether Model for End-stage Liver Disease (MELD) score, Child-Turcotte-Pugh (CTP) score, AST to platelet ratio index (APRI), FiB4 index, and laboratory tests could predict the presence of large EV among patients with liver cirrhosis in Sanglah Hospital Denpasar. Methods: A total of 90 hospitalized liver cirrhosis patients from September 2012 until March 2014 were restrospectively analyzed. Variables used in the analysis included age, sex, etiology of cirrhosis, CTP classification, MELD score, APRI, FiB4 index, platelet count, serum creatinine, and liver function tests. The presence of large EV was correlated with those characteristics. Univariate and multiple regression analysis were used to determine which factors may predict large EV. Results: Of ninety (90) patients enrolled, 66 were male (73.3%) and 24 were female (26.7%); majority with chronic hepatitis B. Sixty (66.7%) of the 90 patients were found to have large EV. The distribution of large EV according to CTP classification was as follows: A, 63.16%; B, 62.8% and C, 75%. Large EV was independently associated with total bilirubin higher than 1.9 mg/dL (p = 0.010), INR higher than 1.65 (p = 0.018), and platelet count lower than 105,500/mm3 (p = 0.02). Platelet count lower than 105,500/mm3 had the highest discriminative value for presence of large EV (sensitivity = 73.33%; specificity = 73.33%; area under receiver operating characteristics = 0.783). Conclusions: Large EV were found in 66.7% of patients with liver cirrhosis who underwent hospitalization. In patients with liver cirrhosis, the existence of thrombocytopenia may predict large EV which warrant prophylactic therapy. Key Word(s): 1. large esophageal varices; 2. liver cirrhosis; 3. platelets