Diagnostic Accuracy of Non-Invasive Parameters for Detecting Esophageal Varices in Cirrhotic Patients in a Resource-Limited Setting

Objectives

This study evaluates the ability of selected non-invasive markers—portal vein diameter (>13 mm), aspartate aminotransferase (AST), AST-to-platelet ratio index (APRI), platelet-to-spleen diameter ratio, spleen size, and INR to detect oesophageal varices in cirrhotic patients accurately. The goal is to reduce reliance on invasive procedures and lower healthcare costs, particularly in resource-limited settings. METHODOLOGY This cross-sectional, prospective study included 165 patients undergoing screening endoscopy, ultrasonography, and laboratory investigations (selected via a non-probability, consecutive sampling technique). The study was conducted at Aga Khan University Hospital, Karachi, from 1st April 2024 to 30th September 2024. Factors associated with oesophageal varices were first analysed using univariable logistic regression analyses. The predictive performance of the final model was evaluated using sensitivity, specificity, positive and negative predictive values, and overall accuracy. Statistical significance was set at p < 0.05. RESULTSSpleen size remained significantly associated with oesophageal varices (p-value = 0.025). Other variables, including age, gender, PVD >13 mm, Ascites, AST, APRI, platelet-to-splenic diameter ratio, and INR, were not independently associated. The model achieved an overall accuracy of 80%, sensitivity of 84%, specificity of 67%, and positive predictive value of 90%, while the negative predictive value was 55% in predicting oesophageal varices.

Conclusion

Among the evaluated non-invasive parameters, spleen size demonstrated the most consistent association with the presence of oesophageal varices, remaining an independent predictor on multivariable analysis. The predictive model incorporating non-invasive markers achieved good overall accuracy with high sensitivity, indicating its usefulness in identifying patients at high risk for oesophageal varices, although specificity and negative predictive value were moderate.