Right liver lobe diameter/albumin ratio and platelet count/spleen diameter ratio as noninvasive predictors of esophageal varices in patients with liver cirrhosis: A cross-sectional study

Abstract

Background: Esophageal varices are a major and potentially life-threatening complication of portal hypertension in patients with liver cirrhosis. Upper gastrointestinal endoscopy remains the gold standard for screening and grading esophageal varices; however, it is invasive, costly, time-consuming, and often poorly tolerated, making repeated surveillance challenging in routine clinical practice. Therefore, there is a growing need for simple, reliable, and noninvasive markers that can help predict the presence of esophageal varices and guide the selection of patients who require endoscopic evaluation. Ultrasonographic and laboratory parameters reflecting portal hypertension and hepatic dysfunction have shown promise, but their predictive accuracy remains variable. Objectives : To evaluate the role of right liver lobe diameter/serum albumin ratio and platelet count/spleen diameter ratio as noninvasive predictors of esophageal varices in patients with liver cirrhosis and to correlate these indices with the presence and grade of esophageal varices. Methods : This hospital-based cross-sectional study included 100 adult patients with liver cirrhosis admitted to a tertiary care center over a period of three months. Cirrhosis was diagnosed based on clinical features, laboratory investigations, and ultrasonographic findings. All patients underwent detailed clinical evaluation, laboratory testing including complete blood count, liver function tests, coagulation profile, and renal function tests, and abdominal ultrasonography with measurement of right liver lobe diameter and spleen diameter. Upper gastrointestinal endoscopy was performed in all patients for detection and grading of esophageal varices. The right liver lobe diameter/albumin ratio and platelet count/spleen diameter ratio were calculated and compared with endoscopic findings. Child–Pugh score was also assessed in all patients. Statistical analysis was performed using appropriate parametric and nonparametric tests, and correlations were evaluated, with a p value <0.05 considered statistically significant. Results : Esophageal varices were detected in a substantial proportion of patients with cirrhosis. Patients with esophageal varices demonstrated significantly higher right liver lobe diameter/albumin ratios and lower platelet count/spleen diameter ratios compared to those without varices. Both indices showed a significant correlation with the presence and increasing grade of esophageal varices. The right liver lobe diameter/albumin ratio, in particular, showed a strong positive correlation with variceal grade, while the platelet count/spleen diameter ratio showed a significant inverse correlation. These findings suggest that the combination of morphologic and biochemical parameters improves the noninvasive prediction of portal hypertension-related complications. Conclusion : Right liver lobe diameter/albumin ratio and platelet count/spleen diameter ratio are simple, inexpensive, and noninvasive indices that can reliably predict the presence and severity of esophageal varices in patients with liver cirrhosis. Their use in routine clinical practice may help reduce unnecessary endoscopies and allow better risk stratification and timely prophylactic intervention in high-risk patients.