Evaluation of the VITRO Score as a Non-Invasive Marker for Esophageal Varices in Liver Cirrhosis

Background Bleeding from esophageal varices is a leading cause of mortality in patients with liver cirrhosis. These varices reflect the presence of clinically significant portal hypertension (CSPH), defined as a portal pressure gradient exceeding 10 mmHg. Currently, the gold standard diagnostic tools—hepatic venous pressure gradient (HVPG) measurement and upper gastrointestinal endoscopy (UGIE)—are invasive, costly, and not routinely accessible. Aim To evaluate the VITRO score (von Willebrand factor antigen/platelet count ratio) as a non-invasive marker for the presence of esophageal varices in patients with CSPH. Patients and Methods: Sixty Egyptian cirrhotic patients were recruited and classified into two groups—those with and without esophageal varices—based on UGIE findings. All participants underwent comprehensive clinical evaluation, hematological and biochemical laboratory testing, and serum von Willebrand factor antigen (VWF) quantification. Results The VITRO score was significantly higher in patients with esophageal varices (median 1.22, IQR: 1.03–1.32) compared to those without (median 0.23, IQR: 0.15–0.40), ( p  < 0.001). VITRO values ranged from 0.78 to 1.92 in the varices group, and from 0.08 to 0.82 in the non-varices group. No significant correlations were observed between the VITRO score and age, WBC count, hemoglobin, renal function, electrolytes, liver enzymes, AFP, or MELD score. ROC analysis revealed a cutoff value of > 0.82 with a sensitivity of 93.75% and specificity of 100% for detecting esophageal varices. Conclusion The VITRO score is a promising non-invasive biomarker for identifying esophageal varices in patients with clinically significant portal hypertension, offering potential to reduce reliance on invasive procedures.