DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20195513

Platelet count splenic diameter ratio as predictor for esophageal varices in patients with cirrhosis: a diagnostic evaluation study

Sunil Mathew, Sachin Chacko, Tomy Philip, R. N. Sharma, Kanniyan Binub

Abstract


Background: Esophageal variceal bleeding is one among the common complication of cirrhosis which is fatal. Latest studies are focusing more on using non-invasive techniques to classify cirrhotic patients according to their risk of having varices. The platelet count-splenic diameter ratio is considered as one such parameter and is used in predicting esophageal varices in patients with cirrhosis. Objectives of the study was to assess the utility of platelet count-splenic diameter ratio as a useful non- invasive parameter in predicting the presence/ absence /size of esophageal varices in patients with cirrhosis.

Methods: Diagnostic evaluation study was done in a tertiary hospital of Kerala state India. 93 adults above the age of 18 yrs with diagnosis of cirrhosis was selected and detailed history, physical, systemic examination and imaging was done. The degree of correlation between platelet count-splenic size ratio and the presence/absence/size of esophageal varices was studied along with its utility as an independent non- invasive marker. Frequency was expressed in percentages.

Results: Best cut-off for prediction of esophageal varices Grade 1 was platelet count/spleen diameter ratio of 954, which had Specificity of 85.7% and Positive predictive value of 94.1% Cut-off for prediction of Grade 2 esophageal varices was platelet count/spleen diameter ratio of 916 which had a Sensitivity of 78.9%, Specificity of 88.9%. Whereas cut-off for prediction of Grade 3 esophageal varices was a ratio of 899 which had a high Sensitivity of 88% and Negative predictive value of 93.6 % but Specificity was only 64.7% and Positive predictive value of 47.8% only.

Conclusions: The platelet count splenic diameter ratio is accurate to be used as screening tool to predict the presence of Grade 2 Esophageal varices in Patients with Cirrhosis. More studies need to be done around the globe for more evidence.


Keywords


Chronic liver disease, Cirrhosis, Esophageal varices, Platelet count splenic diameter ratio

Full Text:

PDF

References


Graham DY, Smith JL. The course of patients after variceal hemorrhage. Gastroenterol. 1981;80(4):800-9.

Christensen E, Fauerholdt L, Schlichting P, Juhl E, Poulsen H, Tygstrup N. Aspects of the natural history of gastrointestinal bleeding in cirrhosis and the effect of prednisone. Gastroenterol. 1981;81(5):944-52.

D'Amico G, Luca A. 3 Natural history. Clinical-haemodynamic correlations. Prediction of the risk of bleeding. Bailliere's Clin Gastroenterol. 1997;11(2):243-56.

D’Amico G, Pagliaro L, Bosch J. Pharmacologic treatmentof portal hypertension: An evidence-based approach. Sem Liver Dis. 1999;19:475-505.

De Franchis R. The North Italian endoscopic club for the study and treatment of esophageal varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. N Engl J Med. 1988;319(983):9.

Bosch J, Abraldes JG, Groszmann R. Current management of portal hypertension. J hepatol. 2003;38(1):54-68.

De Franchis R, Primignani M. Natural history of portal hypertension in patients with cirrhosis. Clini Liver Dis. 2001;5(3):645-63.

Vorobioff J, Groszmann R, Picabea E, et al. Prognosticvalue of hepatic venous pressure gradient measurements inalcoholic cirrhosis: A 10-year prospective study. Gastroenterol. 1996;111:701-9.

Rukhsana JF, Javed IF, Masood R. Outcome after injection sclerotherapy for esophageal variceal bleeding in patients with liver cirrhosis and COPD. J Postgrad Med Inst. 2005;19:76-8

Sarangapani A, Shanmugam C, Kalyanasundaram M, Rangachari B, Thangavelu P, Subbarayan JK. Noninvasive prediction of large esophageal varices in chronic liver disease patients. Saudi J Gastroenterol: official J Saudi Gastroenterol Associat. 2010;16(1):38.

González-Ojeda A, Cervantes-Guevara G, Chávez-Sánchez M, Dávalos-Cobián C, Ornelas-Cázares S, Macías-Amezcua MD, et al. Platelet count/spleen diameter ratio to predict esophageal varices in Mexican patients with hepatic cirrhosis. World J Gastroenterol: WJG. 2014 Feb 28;20(8):2079.

Giannini E, Botta F, Borro P, Risso D, Romagnoli P, Fasoli A, et al. Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis. Gut. 2003;52(8):1200-5.

Schwarzenberger E, Meyer T, Golla V, Sahdala NP, Min AD. Utilization of platelet count spleen diameter ratio in predicting the presence of esophageal varices in patients with cirrhosis. J Clin Gastroenterol. 2010;44(2):146-50.