Association of Platelet Count/Spleen Size Ratio in Relation with Grades of Esophageal Varices and Severity of Chronic Liver Disease (original) (raw)
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The Turkish Journal of Gastroenterology
Background/Aims: Endoscopy as a screening modality for esophageal varices is becoming difficult because of its invasiveness, cost, and increased burden of liver cirrhosis. This study aims to determine the diagnostic accuracy of simple and noninvasive markers in detecting esophageal varices. Materials and Methods: Four variables (platelet count, portal vein diameter, splenic diameter, and ratio of platelet count to splenic diameter PC/SD] ratio) were studied in 150 cirrhotic patients. Endoscopy was performed to detect esophageal varices in the patients. The diagnostic accuracy of these variables was determined by obtaining area under the receiver operating characteristic (ROC) curve (AUC). The cutoff value of each variable and its sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were obtained using the Youden index. Pairwise comparison of these variables was performed using the Hanley and McNeil method to determine the most reliable screening tool among them. Results: The PC/SD ratio was the most reliable indicator for the presence of varices: AUC=0.9 (p<0.0001; cutoff value, ≤1077.42; sensitivity, 88.75%; specificity, 81.43%). The AUC for platelets and splenic diameter was 0.85 (p<0.0001) and 0.77 (p<0.0001), respectively, showing they were also good indicators. The portal vein diameter was not a good predictor for esophageal varices (AUC=0.59). Pairwise comparison of these variables showed that the PC/SD ratio is statistically significant for predicting esophageal varices among these markers (p<0.05). Conclusion: The PC/SD ratio is found to be the most reliable marker to prognosticate esophageal varices. It is easy to obtain and can be used with other markers to identify the high-risk patients for developing esophageal varices. It will definitely reduce the need for endoscopy as screening purposes and lower the medical expenditures.
Platelet count/spleen diameter ratio as a predictor of esophageal varices in cirrhotic patients
Annals of Hepatology, 2010
Introduction: Upper gastro-intestinal endoscopy still remains the gold standard for screening of patients suspected to have esophageal varices but not without limitations. So, this study was conducted to access the diagnostic validity and correlation between non-invasive parameters like platelet count, spleen diameter and their ratio with esophageal varices (EV) in patients with liver cirrhosis. Methods: A hospital based descriptive cross-sectional study was carried out in Liver unit of National Academy of Medical Sciences, Bir Hospital, from October 2016 to September 2017. Complete blood count, liver function tests, liver ultrasound and UGI endoscopy were done for all patients included in the study to detect esophageal varices and the platelet count/spleen diameter (PC/SD) ratio was calculated and analyzed to determine whether it can predict the presence of esophageal varices or not. Results: Total patients of liver cirrhosis studied after exclusion were 191 EV was present in 125 patients (65.4%). The platelet count/spleen diameter ratio using a cutoff value of ≤ 909 to detect EV independent of the grade had 93% sensitivity and 100% specificity and positive and negative predictive values of 100% and 91% respectively. Conclusions: PC/SD ratio now can be used as a predictor of presence of esophageal varices in liver cirrhosis.
Noninvasive prediction of large esophageal varices in chronic liver disease patients
Saudi Journal of Gastroenterology, 2010
Background/Aim: Esophageal varices (EVs) are a serious consequence of portal hypertension in patients with liver diseases. Several studies have evaluated possible noninvasive markers of EVs to reduce the number of unnecessary endoscopies in patients with cirrhosis but without varices. This prospective study was conducted to evaluate noninvasive predictors of large varices (LV). Patients and Methods: The study analyzed 106 patients with liver diseases from January 2007 to March 2008. Relevant clinical parameters assessed included Child-Pugh class, ascites and splenomegaly. Laboratory parameters like hemoglobin level, platelet count, prothrombin time, serum bilirubin, albumin and ultrasonographic characteristics like splenic size, splenic vein size, portal vein diameter were assessed. Univariate and multivariate analysis was done on the data for predictors of large EVs. Results: Incidence of large varices was seen in 41%. On multivariate analysis, independent predictors for the presence of LV were palpable spleen, low platelet count, spleen size >13.8 mm, portal vein >13 mm, splenic vein >11.5 mm. The receiver operating characteristic (ROC) curve showed 0.883 area under curve. Platelet spleen diameter ratio 909 had a sensitivity and specificity of 88.5%, 83% respectively. Conclusion: Thrombocytopenia, large spleen size, portal vein size and platelet spleen diameter ratio strongly predicts large number of EVs.
National Journal of Medical Research, 2014
Background: In patients of chronic liver disease, the parameters directly linked to portal hypertension such as splenomegaly and decreased platelet count were predictors of presence of esophageal varices. The present study was conducted with an objective to find out the predictive efficacy of platelet count / spleen diameter ratio to predict esophageal varices. Materials and Methods: This is a cross sectional study conducted on cases of chronic liver disease using designed data collection protocol. Information about demographic and clinical profile, laboratory parameters, USG and Upper GI endoscopy were collected. Maximum spleen diameter was determined and bipolar spleen diameter was expressed in millimeter (mm). Platelet count/spleen diameter ratio was collected and compared with the presence/absence of esophageal varices. Results: It was observed that 71.4% cases of chronic liver disease caused by Hepatitis B and 87.5% cases of Hepatitis C were having Platelet count/spleen diameter ratio of more than/equal to 909. Sensitivity and specificity of platelet count/spleen diameter ratio for detecting esophageal varices was 98.6% and 96%. Negative predictive value of platelet count / spleen diameter ratio to rule out esophageal varices in chronic liver disease patients was 96% positive predictive value was 98.6%. As the child Pugh class advances from A to C (more decompensation) percentage of patients developing esophageal varices increases with p-value < 0.001 which is highly significant. Conclusion: Platelet count / spleen diameter ratio is a strong parameter which is independently associated with the presence of esophageal varices in chronic liver disease and irrespective of the etiology.
Non-invasive predictors of esophageal varices
Saudi Journal of Gastroenterology, 2011
Background/Aim: Current guidelines recommend screening cirrhotic patients with an endoscopy to detect esophageal varices and to institute prophylactic measures in patients with large esophageal varices. In this study, we aimed at identifying non-endoscopic parameters that could predict the presence and grades of esophageal varices. Patients and Methods: In a prospective study, 229 newly diagnosed patients with liver cirrhosis, without a history of variceal bleeding, were included. Demographic, clinical, biochemical and ultrasonographic parameters were recorded. Esophageal varices were classifi ed as small and large, at endoscopy. Univariate analysis and multivariate logistic regression analysis were done to identify independent predictors for the presence and grades of varices. Results: Of the 229 patients (141 males; median age 42 years; range 17-73 years) with liver cirrhosis, 97 (42.3%) had small and 81 (35.4%) had large varices. On multivariate analysis, low platelet count (Odd's Ratio [OR], 4.3; 95% confi dence interval [CI], 1.2-14.9), Child Pugh class B/C (OR, 3.3; 95% CI, 1.8-6.3), spleen diameter (OR, 4.3; 95% CI, 1.6-11.9) and portal vein diameter (OR, 2.4; 95% CI, 1.1-5.3) were independent predictors for the presence of varices. Likewise, for the presence of large esophageal varices, low platelet count (OR, 2.7; 95% CI, 1.4-5.2), Child Pugh class B/C (OR, 3.8; 95% CI, 2.3-6.5) and spleen diameter (OR, 3.1; 95% CI, 1.6-6.0) were the independent risk factors. Conclusion: The presence and higher grades of varices can be predicted by a low platelet count, Child-Pugh class B/C and spleen diameter. These may be considered as non-endoscopic predictors for the diagnosis and management of large grade varices.
Non-Endoscopic Parameters for Predicton of Esophageal Varices
Advances in internal medicine, 2017
Introduction: Non invasive assessment of esophageal varices may improve the management and lower the medical and financial burden related to the screening. In this study, Our aim was to validate the prediction of varices using platelet count/spleen diameter ratio and Alanine transaminase/platelet ratio index (APRI).Methods: Fifty patients with newly diagnosed and treatment naive cirrhosis underwent screening endoscopy along with hematological and ultrsonographic studies. Platelet count/spleen diameter ratio and APRI index were assessed and their diagnostic accuracy calculated. Based on previous studies, a cutoff of 909 was applied for platelet count/spleen diameter ratio and cutoff of > 1.3 for APRI. The diagnostic accuracy of both the indices were further evaluated for severity and size of varices.Results: Prevalence of varices was 36% out of which 24% were large varices. Platelet count/spleen size diameter, portal vein diameter and APRI index had significant association for pre...
Hepatitis monthly, 2011
Esophageal variceal hemorrhage is a devastating complication of portal hypertension that occurs in approximately one-third of cirrhotic patients. We assessed the value of the platelet count/ bipolar spleen diameter ratio as a noninvasive parameter for the prediction of esophageal varices (EVs) in Egyptian cirrhotic patients. Laboratory and ultrasonographic and imaging variables were prospectively evaluated in 175 patients with liver cirrhosis. All patients underwent upper gastrointestinal endoscopy. Patients with active gastrointestinal bleeding at the time of admission were excluded. The platelet count/ bipolar spleen diameter ratio in patients with EVs was significantly lower than in patients without EVs. In an analysis of the receiver operating characteristic curves (ROCs), we calculated an optimal cutoff value of 939.7 for this ratio, which gave 100% sensitivity and negative predictive values, 86.3% specificity, a 95.6% positive predictive value, and an area under the ROC curve ...
Non-Invasive Predictors of Esophageal Varices in Cirrhosis Patients
American Journal of Gastroenterology, 2017
Background Alcohol is widely consumed socially accepted recreational beverage, that is toxic and affects directly or indirectly almost every organ. Spectrum of alcoholic liver disease ranges from fatty liver to cirrhosis. One of the complications of the later spectrum is portal hypertension, around 50% develops varices and bleeding depends on the size of the varices. Predicting varices without endoscopic is difcult but few non-invasive parameters are available. Materials and Methods It was a prospective cross-sectional study done in Nobel Medical College Teaching Hospital, Biratnagar, Nepal from September 2018 to August 2019. Approval was acquired from Institutional Review Committee. Patients with chronic ethanol ingestion and features suggestive of chronic liver disease clinically and investigation wise were enrolled in the study. History, physical examinations along with platelet count, prothrombin time was taken and ultrasonography abdomen and upper gastrointestinal endoscopy was done to see the splenic diameter, and varices. Results Esophageal varices were present in 53%. Mean platelet count with varices was 122566 ± 36024.8 3 /mm , splenic diameter was 133.1 ± 21.3 mm, prothrombintime (PT) time was 19.3 ± 5.0 sec and ratio 3 3 of platelet per spleen diameter was 930.2 ± 259.4 /mm /mm. Platelet count < 163500/mm has sensitivity and specicity 83.0% and 83.0% respectively. Ratio of platelet per splenic diameter ratio cutoff 1293.7 has 88.7% sensitivity and 85.1% specicity for predicting varices. Conclusion In chronic alcoholic liver disease patients low platelet count, increased splenicdiameter, low platelet per splenic diameter ratio are useful in predicting presence of esophageal varices.
International Journal of Medical Research and Review, 2016
Background: Todays guidelines are clear that there are no substitute markers to determine the presence and size of esophageal varices, and endoscopy is still the only valid method to investigate varices. Objective: To validate the PC/SD ratio as a predictor of the presence and absence of esophageal varices in patients with chronic hepatopathy. Methodology: This study is an analytical cross-sectional validation study of a diagnostic test. The study was done in cases diagnosed of having hepatic cirrhosis by histology or physical, biochemical, and imaging examinations compatible with the disease and treatment from February 1, 2013 to December 31, 2014. Various hematological, biochemical and radiological work up was done. Results: Of the total cases, 29(70.7%) had PC/SD ratio more than 909 and only 12(29.3%) had less than 909. The sensitivity of PC/SD ratio of 909 in predicting varix is 89.66% and specificity was 75%. Thus it can be considered a good and reliable tool for predicting varices. Conclusion: The use of platelet count/ splenic diameter ratio in cirrhotic patients for screening and follow up for esophageal varices can substantially reduce the cost of health care and discomfort for patients as well as reduce burden of endoscopy unit.
Journal of Clinical and Experimental Hepatology, 2016
Introduction: Current consensus recommend screening cirrhotics patients with endoscopy to detect esophageal varices and to begin prophylactic management in patients having large esophageal varices. This study was aimed at finding non invasive parameters which could identify the presence of large esophageal varices. Material and methods: In this prospective study 191 patients with liver cirrhosis without a history of prior gastrointestinal bleed were studied. Epidemiological, clinical, laboratory, and ultrasound parameters were assessed. Esophageal varices were divided as small and large on endoscopy. Univariate and multivariate analysis using binary logistic regression was done to find independent predictors for the presence of large esophageal varices. Results: 191 patients (151 males; median age 43.5 yrs) with liver cirrhosis, [135 had large and 56 had small varices. on multivariate analysis Portal vein diameter >13mm, (Odd's ratio [OR] 62.495 95% Confidence Interval [CI] 10.583 to 369.038) P <0.001S, AUC 0.929], Splenic diameter>120mm, (OR 34.835 95% CI 8.791 to 138.032) P <0.001S,AUC 0.922 and Platelet count <1lakh/mm 3 (OR 11.871 (95% CI 2.515 to 56.036) (P =0.002 S), AUC 0.684] emerged as significant risk factors in the present study. Conclusion: Low platelet count, spleen diameter, and portal vein diameter are significant predictors of large grade esophageal varices. They may be considered as non invasive predictors for large grade varices.