Correlation between Platelet Count and Grading of Esophageal Varices in Liver Cirrhosis Patients: A Meta-Analysis

Abstract

BACKGROUND: Esophageal varices are a major complication of liver cirrhosis. Esophageal varices bleeding is life-threatening and an urgent medical emergency. Low platelet count and esophageal varices are common findings in liver cirrhosis. Platelet count is suggested as a non-invasive screening tool to predict the grading of esophageal varices in liver cirrhosis patients. Several studies have found a correlation between platelet count and grading of esophageal varices in liver cirrhosis patients. However, the results are conflicting.
 AIM: This meta-analysis aimed to evaluate the correlation between platelet count and the grading of esophageal varices in liver cirrhosis patients.
 METHODS: A systematic literature search was performed through the database search from PubMed, SCOPUS, Ovid EMBASE, and EuropePMC to obtain all relevant articles with the following search terms: "correlation" and "platelet" or "thrombocytopenia" AND "esophageal varices" and "liver cirrhosis" or "chronic liver disease" that were published within the year of 2000-2021. Articles were collected by using PRISMA flow diagrams. The data were extracted from the eligible study within inclusion and exclusion criteria. The quality of each study was assessed using the Newcastle Ottawa Scale (NOS). A meta-analysis was conducted to determine the overall pooled correlation coefficient (r) and 95% confidence interval (CI).
 RESULTS: There were a total of 1008 patients from eight included studies. The meta-analysis showed that the pooled correlation coefficient between platelet count and grading of esophageal varices in liver cirrhosis patients was r = -0.42 (95%CI -0.65 to -0.13; p = 0.005; I2 = 96.06%).
 CONCLUSION: There was a moderate negative correlation between platelet count and grading of esophageal varices. Thus, low platelet count may indicate higher grades of esophageal varices in liver cirrhosis patients.

Thrombocytopenia and Grading of Esophageal Varices in Patients With Chronic Liver Disease

“…Thrombocytopenia, a common manifestation in patients with advanced cirrhosis, is one such potential marker. Previous research suggests a reliable correlation between the severity of thrombocytopenia and the presence of varices in patients with CLD [ 6 ]. In this study, we further investigated this relationship, particularly focusing on the ability of thrombocytopenia to predict the grade of EVs.…”

“…The sample size of 94 was calculated, considering the expected correlation coefficient of 0.285. The alpha and beta were set at 0.05 and 0.20, respectively [ 6 ]. The sampling method employed was non-probability consecutive sampling.…”

“…Thrombocytopenia, defined as a platelet count less than 150,000/μL, is a common complication observed in patients with portal hypertension and is prevalent in both cirrhotic and non-cirrhotic conditions. This complication is reported in approximately 76% of patients diagnosed with cirrhosis, highlighting the significant association between portal hypertension and thrombocytopenia [ 6 ]. The pathogenesis of thrombocytopenia in CLD is a multifaceted process involving a decrease in thrombopoietin production, splenic sequestration of platelets, and myelosuppressive effects, all of which culminate in a significant reduction in platelet count [ 4 , 7 ].…”