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

Abstract

AIM: To study the value of platelet count to spleen diameter ratio as a noninvasive parameter for diagnosing esophageal varices (EVs) in liver cirrhosis.METHODS: The laboratory and ultrasonographic variables were prospectively evaluated in 150 patients with liver cirrhosis. Only stable patients were included in the study. Patients with active gastrointestinal bleeding at the time of admission were excluded. All patients underwent screening upper gastrointestinal endoscopy.RESULTS: The platelet count, spleen diameter and platelet count to spleen diameter ratio in patients with EVs were significantly different from patients without EVs. The platelet count to spleen diameter ratio had the highest accuracy among the three parameters. By applying receiver operating characteristic curves, a platelet count to spleen diameter ratio cut-off value of 1014 was obtained, which gave positive and negative predictive values of 95.4% and 95.1%, respectively. The accuracy of this cut-off value as evaluated by applying receiver operating characteristic curves was 0.942 (95% CI 0.890 to 0.995).CONCLUSION: Among the noninvasive parameters studied, platelet count to spleen diameter ratio had the highest accuracy for diagnosing EVs. However, the evidence for the noninvasive diagnosis is not yet sufficient to replace endoscopy as a diagnostic screening tool for EVs in all cirrhotic patients. The platelet count to spleen diameter ratio may be a useful tool for diagnosing EVs in liver cirrhosis noninvasively when endoscopy facilities are not available.

Role of portal haemodynamic parameters in prediction of oesophageal varices in cirrhotic patients

“…This is consistent with Masjedizadeh et al who reported that the platelet count to spleen diameter ratio could not be an appropriate tool to estimate the prevalence of OVs in cirrhotic patients [28]. On the contrary, Giannini et al and Baig et al found that the platelet count to spleen diameter ratio has an excellent diagnostic accuracy for identifying the presence of OVs in cirrhosis patients [6,29]. The difference could be explained by different underlying etiologies and degrees of hepatic dysfunction between both groups of studies.…”

Non Invasive Diagnosis of Esophageal Varices: Can it Replace Screening Endoscopy?

“…Agha et al,(2009) 31 studied114 compensated cirrhotic patients with hepatitis C, they reported that a cut-off value of 909 (NPV=100% and PPV= 93.8%) was effective in the diagnosis of EV. Baig et al, (2008) in their study stated that a cut-off value of 1014can predict presence of OV.…”

Correlation of portal vein diameter, splenomegaly and thrombocytopenia with gastro-espohageal varices in cirrhotic patients

“…Thus the study showed that spleen width, portal vein diameter and prothrombin time may be useful for prediction of large esophageal varices in cirrhotic patients. 11 in their study of 150 patients of cirrhosis evaluated laboratory and ultrasonographic variables prospectively. Only stable patients were included in the study.…”