article · Medicine
Endoscopy is standard for detecting oesophageal varices in liver cirrhosis, but the procedure is invasive and costly. A prospective study of 110 Egyptian patients with liver cirrhosis evaluated whether platelet counts and the FIB-4 index could predict the presence of varices, particularly large lesions requiring preventive treatment. Oesophageal varices were present in approximately 79 percent of the cohort. Patients with platelet counts below 150,000 had higher rates of moderate and severe varices than those with normal counts. A platelet threshold of 149,000 yielded 82 percent specificity for detecting varices, while a FIB-4 threshold of 3.175 provided 83.3 percent sensitivity for identifying large varices. These non-invasive measures could help patients with normal platelet counts avoid screening endoscopy, especially in resource-limited settings where clinical costs must be minimised.
Routine endoscopic screening for complications of liver cirrhosis is uncomfortable, invasive, and costly. Demonstrating that standard blood tests can identify patients at low risk of bleeding allows clinicians to reserve endoscopies for those in urgent need. This approach reduces unnecessary interventions and eases financial and logistical pressures on healthcare facilities, particularly in developing regions.
This research informs clinical triage pathways and diagnostic protocols for healthcare providers managing liver cirrhosis. Because the approach relies on standard blood counts and calculations rather than novel devices, it is applied clinical research rather than a direct commercial product. However, clinical decision-support software providers could integrate these cut-off values into automated risk stratification tools for gastroenterology practices.
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Screening endoscopy is recommended for early detection of esophageal varices (EVs) in cirrhotic patients with portal hypertension. However, this approach is limited by its invasiveness and cost. The aim of the study was to determine if platelet count can predict the presence of EVs, especially large (grade III, IV) EVs in need of prophylactic therapy, in a cohort of Egyptian patients with liver cirrhosis. In all, 110 patients with cirrhosis were prospectively analyzed. The presence of medium or large EVs was correlated with patients' platelet count and FIB-4. Esophageal varices were present in 87 (79.09%) patients. Among those with thrombocytopenia (platelet level below 150,000), 25.97% (20 patients) and 27.27% (21 patients) had EV grade II and EV grade III or IV, respectively. Whereas in patients in whom the platelet count was above 150,000, only 21.21% (7 patients) and 9.09% (3 patients) of patients had grade II EV and EV grade III or IV, respectively. A platelet count cut-off value of 149,000 was found to have specificity of 82% and sensitivity 39% for detection of presence of varices. A FIB-4 cut-off value of 3.175 was found to have an 83.3% sensitivity and 39.5% specificity in detecting large (grade III, IV) EVs. Platelet count is a noninvasive parameter with high accuracy for prediction of EVs. Cirrhotic patients with normal platelet counts (above 150,000), especially in financially deprived developing countries, can avoid screening endoscopy as they are at a low risk for variceal bleeding, and presence of large EVs in these patients is much less common than in those with thrombocytopenia. A 3.175 cut-off value of FIB-4 could be useful as a noninvasive predictor of large varices requiring prophylactic banding in cirrhotic patients.
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DOI: 10.1097/md.0000000000003853
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