Screening of Esophageal Varices by Noninvasive Means in 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.
International Journal of TROPICAL DISEASE & Health
Background: Esophagogastroduodenoscopy (EGD) is the gold standard for detecting oesophageal varices (OVs) in cirrhotic patients. However, due to the possible limitations of EGD, there has been much interest in the use of non-invasive techniques for this purpose. This study aimed to evaluate the use of platelet count/ spleen diameter ratio (PC/SD) in the prediction of the presence and grading of OVs in cirrhotic patients. Methods: One hundred cirrhotic patients were included in this cross-sectional study and subjected to EGD after informed consent. Either absence or the grade of OVs if existent was correlated with values of the PC/SD ratio. Univariate and multivariate analyses of data and areas under the receiver operating characteristic curve (AUC) were used. Results: The PC/SD ratio was a good indicator in predicting the development of OVs (AUC of 0.897) with cut-off values of (987.28). Also, it correlated well with grades of oesophageal varices, a significant stepwise progressive ...
Journal of Translational Internal Medicine, 2014
Background: Esophageal varices (EVs) are serious consequences of liver cirrhosis. Several studies have evaluated the possible non-invasive markers for the diagnosis of EVs to reduce the number of endoscopic procedures in patients with cirrhosis but without varices. This study was performed to evaluate the diagnostic performance of two such parameters (platelet count to splenic diameter ratio and splenoportal index) for the detection of EVs. Materials and Methods: A total of 111 patients with liver cirrhosis were analyzed after performing upper gastrointestinal endoscopy and non-invasive tests including platelet count and ultrasound abdomen including Doppler study. Appropriate statistical tests were applied to compare the non-invasive tests with the gold standard of endoscopy. Results: Of 111 liver cirrhotics, 80 (72.1%) were male and 31 (27.9%) were female. EVs were present in 68 (61.3%) patients and absent in 43 (38.7%) patients. In platelet count to splenic diameter ratio, a cut-o...
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.
https://www.ijrrjournal.com/IJRR\_Vol.7\_Issue.10\_Oct2020/Abstract\_IJRR0054.html, 2020
Background: Most serious complication of portal hypertension in patients with liver diseases is esophageal varices. This study was conducted to evaluate non-invasive predictors of large esophageal varices in comparison with small or absent varices in patient with cirrhosis. Objective: To assess the association of platelet count/spleen size ratio in relation with severity of varices and to compare with Child Pugh's score of chronic liver disease. Methodology: A Hospital based cross section study was conducted in Department of General Medicine and Gastroenterology. The study population is of 90 who were diagnosed to have chronic liver disease based of ultrasonogram and biochemical test. Results: Incidence of large varices was seen in 34.4%. Onmultivariate analysis, only spleen diameter is independent predictors for the presence of large varices with mean size of 14.2cm. The sensitivity of PC/SD Ratio of ≤ 909 in predicting presence of esophageal varices in our study was 61.29 and specificity was 61.02%. However, the mean PC/SD to predict the large esophageal varices in our study was ≤ 962.3 and small and absent varices was 1172.7. Although there is significant reduction in PC/SD ratio between the two groups it was not statistically significant. Conclusion: From our study we conclude that presence of splenomegaly and lower PC/SD ratio determine the presence of higher grades of varices and can hence identify the patients who require endoscopy for the prophylactic management of esophageal varices.
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.
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.
The Professional Medical Journal, 2021
Objectives: To determine the correlation between mean platelet count and grading of esophageal varices in patients of liver cirrhosis. Study Design: Cross Sectional study. Settings: Department of Medicine, DHQ Hospital (FMU) &AFM&DC Faisalabad. Period: 17th August 2019 to 16th February 2020. Material & Methods: A total of 105 patients liver cirrhosis with esophageal varices were included in the study according to the inclusion and exclusion criteria. For assessment of platelet count 2ml blood sample was sent to hospital pathology laboratory and it was reported by the pathologist. Upper GI endoscopy was performed by gastroenterologist for confirmation and grading of oesophageal varices. Results: In our study, it was observed that 04 (3.81%) patients had grade- I EV, 34 (32.38%) Grade-II, 39 (37.14%) Grade III, 15 (14.29%) Grade IV and 13 (12.38%) patients had Grade V esophageal varices. While correlating the mean platelet count and grading of esophageal varices in patients of liver c...
Platelet Spleen Index is a Noninvasive Technique to Detect Esophageal Varices in Cirrhotics
Pakistan Journal of Medical and Health Sciences
Background: noninvasive esophageal parameters may prevent the need for an esophagogastroduodenoscopy. Liver cirrhosis patients may benefit from the PC/SD ratio and the platelet count to spleen diameter (PC/SD) ratio, both of which are noninvasive yet useful indicators of liver cirrhosis progression. Objective: This study aimed to evaluate the diagnostic accuracy of the platelet spleen index for the diagnosis of gastric varices in patients with cirrhosis, using esophagogastroduodenoscopy as the reference standard. Methodology: A-Cross-sectional descriptive validation The study was conducted over the course of three months, from October, 2019 to December 2019. At the Gastroenterology A tertiary care hospital. The study comprised 90 participants. In addition to the requisite blood tests, abdominal ultrasonography was used to evaluate the size of the spleen. TYPE SIZE The sensitivity is 83%, the specificity is 66%, and the accuracy is 83% Variations were found in 24% of cirrhotic indivi...
Journal of Evidence Based Medicine and Healthcare, 2018
BACKGROUND Most cirrhotic patients will develop oesophageal varices over their lifetime and the annual rate of oesophageal haemorrhage is 5 to 15%. Current guidelines recommend using Upper Gastrointestinal Endoscopy (UGIE) to screen all cirrhotic patients at diagnosis for identification of varices at a high risk of bleeding. In a limited resources setting like ours where financial constraints are a major problem predicting the presence and grade of varices by non-invasive methods serves to help a lot in various ways. The aim of the study is to find out the relevance of platelet count-spleen diameter ratio as a non-invasive predictor of oesophageal varices in patients with hepatic cirrhosis. MATERIALS AND METHODS The present study was conducted on 100 patients admitted with a diagnosis of cirrhosis of liver in general medicine wards of M.K.C.G. Medical College, Brahmapur, during the period of 2 years. All the patients underwent detailed clinical evaluation, total platelet count, ultrasound abdomen and varices were graded by upper GI endoscopy with Paquet's grading. Statistical Analysis-All data were entered in Excel 2007 and statistical analysis was performed using the statistical software SPSS 16.0. Data were expressed as frequency (in percentages), median values (with range (minimum, maximum)). For continuous variables, Mann-Whitney U test was performed to find the differences between two groups. Study Design-Cross-sectional analytic study. RESULTS 100 patients with hepatic cirrhosis were evaluated with upper GI endoscopy, ultrasound abdomen and total platelet count. Median platelet count in large varices group was 90,100 and in small varices group was 2 lakhs. Large varices were significantly correlated with increasing spleen size, median value-182.5 mm. Platelet count-spleen diameter ratio was significantly low in patients with higher grade of oesophageal varices. CONCLUSION This study shows significant association between low platelet count, higher spleen size and lower platelet count-spleen diameter ratio with the presence of large oesophageal varices. These parameters can be used as non-invasive predictors of oesophageal varices in patients with hepatic cirrhosis, but never comparable with upper GI endoscopy in terms of sensitivity and specificity in prediction of variceal haemorrhage.