Risk factors for the presence of varices in cirrhotic patients without a history of variceal hemorrhage

Background: Current medical management dictates that all cirrhotic patients without a history of variceal hemorrhage undergo endoscopic screening to d etect large varices. However, referral for endoscopic screening of only pat ients at highest risk for varices may be most cost-effective. The aim of th is case-control study was to identify clinical, laboratory, and radiologic findings that predict the presence of varices in patients with cirrhosis. Methods: Three hundred patients without a history of variceal hemorrhage un derwent upper endoscopy as part of an evaluation before liver transplantati on. Cases defined as the presence of any varices and cases defined as the p resence of large varices were used for examining the risks associated with finding varices on upper endoscopy. Logistic regression was performed to ev aluate associations between the presence of varices and patient characteris tics. Results: Platelet count and Child-Pugh class were independent risk factors for the presence of any varices and the presence of large varices. For the presence of any varices, a platelet count of 90 X 10(3)/muL or less (odds r atio [OR], 2.4; 95% confidence interval [CI], 1.4-4.0) and advanced Child-P ugh class (OR, 3.0; 95% CI, 1.6-5.6) were independent risk factors. For lar ge varices, a platelet count of 80 X 10(3)/muL or less (OR, 2.3; 95% CI, 1. 4-3.9) and advanced Child-Pugh class (OR, 2.8; 95% CI, 1.3-5.8) were indepe ndent risk factors associated with varices. Conclusions: Low platelet count and advanced Child-Pugh class were associat ed with the presence of any varices and with large varices. These factors a llow identification of a subgroup of cirrhotic patients who would benefit m ost from referral for endoscopic screening for varices.