INR-PLATELET RATIO AS A PREDICTOR OF ESOPHAGEAL VARICES IN MEXICAN CIRRHOTIC PATIENTS

Abstract

Introduction and Objectives

High mortality from esophageal variceal bleeding necessitates primary prophylaxis in cirrhosis. Mexico's endoscopy-limited settings require biochemical predictors like the INR-Platelet Ratio (INPR) for variceal detection.The present work proposes that the INPR retains predictive validity for esophageal varices in Mexican cirrhotic patients.Consequently, validation of this hypothesis constitutes the primary objective of this investigation.

Patients and Methods

An observational, single-center study was conducted in the Gastroenterology Department of Hospital Juárez de México between 2023 and 2024.Inclusion criteria:Patients aged over 18 years with a diagnosis of cirrhosis confirmed by FIB-4 or hepatic ultrasound,and no prior endoscopic screening.A total of 139 patients were included: 71 women (51.1%) and 68 men (48.9%). Statistical analyses were performed using IBM SPSS Statistics software. Descriptive population analyses utilized frequencies and medians.Group comparisons were conducted using the chi-square test and Student’s t-test,with a p-value <0.05 considered statistically significant.ROC curves and the Youden index were employed to identify optimal cutoff values for sensitivity and specificity.

Results

Using an INPR cut-off of ≥0.9463 for detecting esophageal varices (irrespective of size), the following performance metrics were achieved: sensitivity 83%, specificity 71%, PPV 85%, NPV 66%. +LR 2.87, -LR 0.24.

Conclusions

The INR-Platelet Ratio is an efficient tool for healthcare providers to initiate screening and prioritize early endoscopy, particularly in patients with other risk markers such as thrombocytopenia or Child-Pugh B/C cirrhosis.Future studies should evaluate its cutoff points to reduce unnecessary endoscopies and improve timely complication detection.