The development of esophageal varices in patient with liver cirrhosis is a common complication. The prevalence of esophageal varices among these patients may range from 60 – 80 %. Regular upper endoscopy is now recommended for all patients with liver cirrhosis. So if a simple, noninvasive test is available, many low-risk patients may reliably avoid endoscopy. •Objectives : large-scale validation study of a simple, noninvasive test called P2/MS based on complete blood counts, (platelet count) 2 / [monocyte fraction (%) x segmented neutrophil fraction (%)], and compare it with other predictive tests for HREV in cirrhotic patients such as the age-spleen platelet ratio index , spleen-platelet ratio index , age-platelet index , aspartate aminotransferase (AST)-platelet ratio index and AST-alanine aminotransferase ratio. •Results: P2/MS predict presence of HREV with high accuracy when compared to other predictive test (AUROC=0.897 – p-value=0.000). At a P2/MS cut-off value of 28.84 the test achieved a PPV of 79.7%, sensitivity 89.4%, specificity 74.6%, NPV 86.3% and total accuracy of 82.4% Thus, P2/MS reliably predicted HREV if the result equal to or less than 28.84 with high accuracy. We detect a new test variable giving results higher than P2/MS (AUROC=0.909 – P-value= 0.000). At a new test cut-off value of 0.5743 the test achieved a PPV of 87.9 %, sensitivity 85.3%, specificity 83.1%, NPV 86.0% and total accuracy of 85.6%. But with this cut off value high risk esophageal varices positive if the result is greater than or equal to this number. •Conclusion: We externally validated the P2/MS index for predicting HREV in a relatively large group of patients with cirrhosis. The test compared favorably in diagnostic accuracy with other noninvasive tests. We found that we can use P2/MS to optimally select patients for endoscopic screening and reliably avoid many costly and unnecessary procedures. We detect anew variable test which gives higher results than P2/MS in prediction of HREV.