Platelet count to splenic diameter ratio and other noninvasive markers as predictors of esophageal varices in patients with liver cirrhosis (original) (raw)
Related papers
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...
New Non-Invasive Index for Detecting Esophageal Varices in Patients with Liver Cirrhosis
Open Journal of Internal Medicine, 2016
Introduction: Many studies have shown that clinical, biochemical and ultrasonographic parameter are predictive of the presence and grading of esophageal varices. Aim of Study: Validation of a noninvasive test called P2/MS and its comparison with other noninvasive tests for the detection of high risk esophageal varices. Patients and Methods: We prospectively enrolled 125 consecutive patients with liver cirrhosis. Complete blood count [CBC], Platelet count by direct method, Liver functions [serum bilirubin, AST, ALT, prothrombin time and concentration and serum albumin], kidney functions, hepatitis markers for B & C, abdominal ultrasonography and upper gastrointestinal endoscopy were done for each patient. Calculation of P2/MS [Platelet count) 2 /{monocyte fraction (%) × segmented neutrophil fraction (%)], API [age-platelet index], APRI [AST-to-platelet ratio index], SPRI [spleen-toplatelet ratio index], ASPRI [age-spleen-to-platelet ratio index] scores and correlating the different scores with the grade of esophageal varices found on upper endoscopy. Results: During processing of our patient's data, we found certain relation between segmented neutrophils, monocytes, platelet count, total bilirubin and the degree of esophageal varices for the detection of high risk varices and a new equation was formulated and we called it P2/MS-B. In predicting high risk esophageal varices HREV, the area under the curve for this new variable was [0.909, 95% confidence interval 0.858-0.961, p = 0.000] which was significantly higher than all the other variables including P2/MS for the detection of HREV. The sensitivity of the new equation for the detection of HREV is 85.3%, the specificity is 83.1%, the positive predictive value is 87.9%, the negative predicative value is 86.0 % and the overall accuracy of the test is 85.6%. Conclusion: A newly detected noninvasive variable for detecting HREV may reliably screen liver cirrhosis patients for HREV and avoid unnecessary endoscopy in low risk patients.
Screening of Esophageal Varices by Noninvasive Means in Chronic Liver Disease
Euroasian journal of hepato-gastroenterology
Noninvasive assessment of esophageal varices (EV) decreases the medical and financial burden related to screening and helps in the management of patients with chronic liver diseases (CLDs). In this study, our aim was to assess the utility of the platelet count/spleen diameter index for the noninvasive evaluation of EV. In this cross-sectional observational study, a total of 100 CLD patients underwent screening endoscopy for EV in Medicine and Gastroenterology Department, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh. Platelet count/spleen diameter ratio was assessed in all patients and its diagnostic implication was calculated. Upper gastrointestinal endoscopy revealed that 45 (45.0%) patients had medium EV followed by 27 (27.0%) that had small EV and 19 (19.0%) patients had large EV. Receiver operator characteristic (ROC) curve was constructed using platelet count/spleen index, which gave a cut-off value of >905. The validity of platelet count/spleen index evalu...
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.
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...
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.
Significance of Non-Invasive Markers as Predictor of Esophageal Varices in Liver Cirrhosis
Journal of Nepal Medical Association, 2017
Introduction: Upper gastro-intestinal endoscopy remains the gold standard for screening for esophageal varices but it has its own limitations. It is an invasive, expensive and uncomfortable procedure and needs clinical expertise. Accordingly, this study was conducted to establish the role of non-invasive markers for prediction of esophageal varices in 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 test, liver ultrasound and upper gastro-intestinal endoscopy were done for all patients to detect esophageal varices and to correlate with different non-invasive markers. Results: Total 191 patients of liver cirrhosis were studied after exclusion. Platelet count of 92082.00±43435.83/mm3 and spleen size of 144.21±10.71 mm was found to be good predictors of presence of EV (P≤0.001). Significant association...
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 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.