Platelet count is not a predictor of the presence or development of gastroesophageal varices in cirrhosis

Abstract

Current guidelines recommend esophagogastroduodenoscopy (EGD) in patients with cirrhosis to screen for gastroesophageal varices (GEV). Thrombocytopenia has been proposed as a noninvasive test to predict the presence of GEV. There is no agreement regarding a specific platelet count (PLT) that can reliably predict GEV. The present longitudinal study aims to (1) further investigate the relationship between varices and PLT at the time of endoscopy, (2) investigate whether changes in PLT from the baseline over time can predict the development of GEV, and (3) investigate whether changes in PLT correlate with the hepatic venous pressure gradient (HVPG). A secondary analysis was conducted for 213 subjects with compensated cirrhosis with portal hypertension but without GEV enrolled in a randomized, placebo-controlled, double-blind trial of a nonselective beta-blocker used to prevent GEV. PLTs were obtained every 3 months, and HVPG measurements and EGD were done annually. The PLTs were compared between subjects who did and did not develop GEV. In a median follow-up of 54.9 months, 84 patients developed GEV. PLT was greater than 150,000 in 15% of patients at the development of GEV. A receiver operating curve did not show any PLT with high sensitivity or specificity for the presence of GEV. Subjects with clinically insignificant portal hypertension (HVPG < 10 mm Hg) whose PLT remained greater than 100,000 had a 2-fold reduction in the occurrence of GEV (P ‫؍‬ 0.0374). A significant correlation was found between HVPG and PLT at the baseline, year 1, and year 5 (P < V ariceal hemorrhage is a leading cause of morbidity and mortality in cirrhosis. 1-3 Primary prophylaxis with nonselective beta-blockers and endoscopic therapy with band ligation are effective in preventing variceal hemorrhage in patients with large varices. 1 Current guidelines recommend screening for gastroesophageal varices (GEV) with esophagogastroduodenoscopy (EGD) in all patients with cirrhosis and starting prophylactic therapy in those with medium to large varices. [4][5][6][7] In patients without varices, EGD is repeated in 2-3 years, whereas in patients with small varices, the recommendation is to repeat EGD in 1-2 years. 2 Because of the cost and invasive nature of endoscopic screening, there is interest in developing a noninvasive predictor of the presence and development of GEV that would decrease the number of EGDs performed. The ideal noninvasive marker should be widely available at a reasonable cost, require minimal expertise, be reproducible, and be relatively unaffected by any other factors. A number of clinical, laboratory, and ultrasonographic variables have been considered. 8 However, the accuracy of these variables in predicting varices is currently inadequate to be recommended for clinical practice. 2 As varices are a direct consequence of portal hypertension, it is not surprising that the degree of portal hypertension determined by the hepatic venous pressure gradient (HVPG) has been found to be predictive of the

Platelet Count to Spleen Diameter Ratio for the Diagnosis of Esophageal Varices: Is It Feasible?

“…However, most current guidelines (26)(27)(28) recommend that all cirrhotic patients be screened by upper gastrointestinal endoscopy for the presence of EVs at the time of diagnosis. This argues against the accuracy of noninvasive predictors of EVs.…”

Non-Invasive Measurement of Systemic Haemodynamics by Finometry in Patients with Cirrhosis

“…These include tests assessing the degree of liver fibrosis such as Fibroscan [20][21][22][23][24] or fibrotest [25], or identifying consequences of portal hypertension such as with platelet count or platelet count to spleen diameter ratio [26][27][28][29][30][31]. To date, none of these tests have proved accurate enough to replace endoscopic screening.…”

Noninvasive assessment of portal hypertension in patients with alcoholic cirrhosis

“…Qamar (31) suggested, based on results of both the cross-sectional and longitudinal evaluation of 213 cirrhosis patients, that platelet count cannot be used as an adequate noninvasive marker for gastroesophageal varices and that current guidelines for endoscopic screening should be followed. Patients with mild portal hypertension whose platelet count is over 100,000 have significantly lower incidence of large gastroesophageal varices and subsequent variceal hemorrhage.…”