About half of cirrhotic patients have esophageal varices, and about a third of all patients with varices suffer from variceal bleeding. Variceal bleeding is one of the gastrointestinal emergencies and one of the main causes of death in cirrhotic patients. Each episode of active variceal bleeding is associated with about 20% mortality. Patients with liver cirrhosis should undergo endoscopic screening to check the presence of esophageal varices, so that prophylactic treatment can be performed in patients who are at increased risk of bleeding. In patients with compensated liver cirrhosis who do not have esophageal varices, endoscopic screening is performed every 2 to 3 years. Patients with small varicose veins undergo endoscopic screening every 1 to 2 years and every year for patients with decompensated liver cirrhosis. The size of esophageal varices can provide an estimate of the risk of bleeding. In the grading system of esophageal varices, grade F1 is straight and small varices, grade F2 is enlarged tortuous varices that occupy less than one-third of the lumen, and grade F3 is large coil-shaped varices that occupy more than one-third of the lumen. Several non-invasive methods, including the ratio of aspartate aminotransferase to platelet count, ratio of platelet count to spleen diameter, ratio of aspartate aminotransferase to alanine aminotransferase, MELD score , FIB-4 and Child Turcotte Pugh score were studied to predict the presence of esophageal varices in patients with liver cirrhosis. However, none of the mentioned cases could replace endoscopic screening. In this study , we tried to evaluate laboratory criteria and the possibility of using them to predict the presence of esophageal varices and the degree of them.

This study is a retrospective cohort study in which 179 patients with liver cirrhosis who underwent upper endoscopy in Imam Khomeini Hospital between 1397 and 1401 were evaluated. The variables investigated in this study include age, sex, number of Platelet, serum levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total bilirubin and albumin, INR level, ratio of serum levels of aspartate aminotransferase to alanine aminotransferase, ratio of serum levels of aspartate aminotransferase to the number of platelets, diameter of the spleen, ratio of the number of platelets to the diameter of the spleen, FIB-4 score is MELD score. The relationship of the mentioned variables with the presence of esophageal varices and its degree was evaluated in this study.

Platelet count with a cutoff of 147,500 and a sensitivity of 82% and a specificity of 47.4% was a predictor of esophageal varices. Spleen diameter with a cut-off of 120.5 mm with a sensitivity of 90.7% and a specificity of 42.1% was a predictor of the presence of esophageal varices. In this study, the ratio of platelet counts to the diameter of the spleen with a cut-off of 934.37 with a sensitivity of 78.7% and a specificity of 60.5% was a predictor of the presence of esophageal varices. Also, in this study, it was found that ALT variable was significantly different among three degrees of esophageal varices. So that the level of ALT in patients with 1st degree of esophageal varices was higher than that of 2nd degree of esophageal varices.

According to the results obtained from the present study and previous studies, it seems that it is possible to predict the presence of esophageal varices from the number of platelets, the diameter of the spleen, and the ratio of the platelet counts to the diameter of the spleen in patients with liver cirrhosis. The use of these laboratory criteria reduces the need to use upper endoscopy as an invasive method and thus leads to a reduction in the cost of managing cirrhotic patients in the health care system.