Non-invasive parameters as predictors of high risk of variceal bleeding in cirrhotic patients

Variceal bleeding (VB) is a serious complication in cirrhotic patients. Hepatic pressure venous gradient (HPVG) is the gold standard to assess high risk of VB, but, this is not always available and is an invasive method. Therefore is necessary to explore if non-invasive parameters are useful as predictive factors of high risk of VB.ObjectiveTo evaluate if low platelet count, spleen size, platelet count/spleen size ratio, portal vein diameter, blood flow velocity of the portal vein, congestion index of the portal vein, and variceal size could be useful as non-invasive parameters for predicting high risk of VB in cirrhotic patients.Subjects and methodsObservational, cross sectional study, that includes 99 cirrhotic patients with esophageal varices. For predictive analysis we considered as the dependent variable “presence of VB” and the independent variables we tested were: Child-Pugh score, platelet count, spleen size, portal vein diameter, platelet count/spleen size ratio, blood flow velocity of the portal vein, congestion index of the portal vein, variceal size. Univariate and multivariate logistic regression were performed.Results99 cirrhotics with esophageal varices were included, 56 (56.6%) were female, the mean of age was 57.8±12.2. About variceal size, 54 (54.5%) of patients had large varices. Regarding to occurrence of VB, 46 (46.5%) presented it. In the multivariate analysis, the presence of large varices in the endoscopic study was the best predictor of VB (OR=11.1; 95% CI=3.9 to 32.8, P<0.0001). Portal vein diameter ≥ 13mm results with an OR=5.0; 95% CI=1.1 to 21.7, P=0.03ConclusionsThe presence of large esophageal varices is the most important predictive risk factor for the occurrence of VB, independently of the class of Child-Pugh. Additionally, the portal vein diameter ≥ 13mm is a non-invasive parameter related to high risk of VB. Therefore, these factors could be used as predictors of high risk of VB when the measure of HPVG is not available