Rapid Prediction of Esophageal Varices in Patients with Liver Cirrhosis

Introduction: The development of esophageal varices in patient with liver cirrhosis is a common complication. The prevalence of esophageal varices among these patients may range from 60-80%. Regular upper endoscopy is now recommended for all patients with liver cirrhosis. So, if a simple, noninvasive test is available, many low-risk patients may reliably avoid endoscopy.Aim of Work: Large-scale validation study of a simple,noninvasive test called P2/MS based on complete blood counts,(platelet count) 2 / [monocyte fraction (%) x segmented neutrophil fraction (%)], and compare it with other predictive tests for high risk esophageal varices (HREV) in cirrhotic patients such as the age-spleen platelet ratio index, spleenplatelet ratio index, age-platelet index, aspartate aminotransferase (AST)-platelet ratio index and AST-alanine aminotransferase ratio.Results: P2/MS predict presence of HREV with high accuracy when compared to other predictive test (AUROC =0.897 -p-value=0.000). At a P2/MS cut-off value of 28.84 the test achieved a PPV of 79.7%, sensitivity 89.4%, specificity 74.6%, NPV 86.3% and total accuracy of 82.4% Thus, P2/MS reliably predicted HREV if the result equal to or less than 28.84 with high accuracy.Conclusion: We externally validated the P2/MS index for predicting HREV in a relatively large group of patients with cirrhosis. The test compared favorably in diagnostic accuracy with other noninvasive tests. We found that we can use P2/MS to optimally select patients for endoscopic screening and reliably avoid many costly and unnecessary procedures.