Noninvasive predictors of oesophageal varices in alcoholic cirrhosis in a tertiary care centre

Non-invasive predictors of varices in cirrhosis would reduce the need for
screening endoscopies.Aim of this study is to assess the role of non invasive markers like platelet count-spleen diameter ratio, APRI(AST/platelet ratio index),AST/ALT ratio,Lok score, FIB4 score to predict oesophageal varices in alcoholic cirrhosis.
Method: 48 patients with alcoholic cirrhosis who came for index screening of varices
were prospectively evaluated for non invasive markers using laboratory tests
like platelet count, AST, ALT, INR, USG abdomen and were subjected for endoscopy for evaluation of varices. The diagnostic performances of the non invasive markers were assessed using sensitivity, specificity, positive predictive value and negative predictive value
Results: 48 patients with alcoholic cirrhosis with mean age of 46 years were included
for the study. Majority belonged to Child C (22 patients, 46%) followed by
Child B (14 Patients, 29%) and Child A (12 patients, 25%). AST/ALT ratio and FIB4 score have better sensitivity and positive predictive value for prediction of varices (80%&84% and 80% & 84% respectively) than APRI, Lok score and platelet count-spleen diameter ratio (60% & 85%; 60% & 80%;70% & 82%). Compared to their role in hepatitis C the non invasive markers are less specific (specificity in range of 25% and low negative predictive value around 12%) in alcoholic cirrhosis for predicting varices except for Lok score in predicting
large varices (50% specificity).
Conclusion: Non invasive markers though sensitive are less specific in predicting
oesophageal varices in alcoholic cirrhosis.