DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20212225

Correlation of platelet count/splenic diameter ratio for the diagnosis of esophageal varices in patients of cirrhosis of liver

Waghralkar Mandar, Somannavar Vijay

Abstract


Background: In patients with cirrhosis, endoscopic screening for esophageal varices is currently recommended as a gold standard tool at the time of diagnosis of cirrhosis and to institute prophylactic measures in patients with large esophageal varices. Newer methods have been proposed as alternatives to conventional endoscopy for the non-invasive or minimally invasive diagnosis of esophageal varices.

Methods: This one year observational study was done in the Department of Medicine at Dr. Prabhakar Kore Hospital MRC Belagavi. A total of 70 patients with cirrhosis of liver were included in the study. Relevant clinical examination, laboratory workup like complete blood count, liver function test, ultrasound abdomen and all patients underwent screening upper gastrointestinal endoscopy. Platelet count to spleen diameter ratio was calculated for all patients.

Results: 54 (77.14%) had varices. Males predominated with 64 (91%). Majority patients ranged in between 31-50 years. Evidence of esophageal varices was more common with cirrhosis secondary to alcoholism as compared to hepatitis B virus (HBV) and hepatitis C virus (HCV). The child Pugh score, platelet count, spleen size, platelet count/spleen diameter ratio in patients with varices was significantly different from patients without varices. Platelet count spleen diameter ratio cutoff value of 909 was obtained with sensitivity of 77% and specificity of 79%. The positive predictive value was 88% and negative predictive value was 62%.

Conclusions: The platelet count to spleen diameter ratio may be useful inexpensive tool for diagnosing esophageal varices in liver cirrhosis noninvasively when endoscopy facilities are not available.


Keywords


Esophageal varices, Liver cirrhosis, Platelet count to spleen diameter ratio, Endoscopy

Full Text:

PDF

References


Gupta BM, Bala A, Ahmed M, Gupta R. Liver disorders: A scientometric study of publication outputs from India during 2003-2012. Int J Med Public Health. 2014;4(1):9-16.

Gonzalez-Ojeda A, Cervantes-Guevera G, Chavez-Sancgez M, Davalos-Cobian C, Ornelas-Cazares S, Macias-Amezcua MD, et al. Platelet count/spleen diameter ratio to predict esophageal varices in Mexican patients with hepatic cirrhosis. World J Gastroenterol. 2014;20(8):2079-84.

Gilbert A, Villaret M. Contribution al’etude du syndrome d’hypertensionportale; cytologie des liquidesd’ascitedans les cirrhoses. Comptes Rendus des Séances et Mémoires de la Société de Biologie. 1906;60:820-3.

D’Amico, Lucia A. Natural history, clinical-hemodynamic correlation, prediction off the risk of bleeding. Baillieres Clin Gastroenterol. 1997;11:243-56.

Garcia-Tsao G, Groszmann RJ, Fisher RL, Conn HO, Atterbury CE, Glickman M. Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology. 1985;5:419-24.

Pagliaro L, D’Amico G, Pasta L, Politi F, Vizzini G, Traina M, et al. Portal hypertension in cirrhosis: Natural history. In: Bosch J, Groszmann RJ. Portal Hypertension. Pathophysiology and Treatment. Oxford, UK: Blackwell Scientific. 1994;72-92.

Merli M, Nicolini G, Angeloni S, Rinaldi V, De Santis A, Merkel C, et al. Incidence and natural history of small esophageal varices in cirrhotic patients. J Hepatol. 2003;38:266-72.

Giannini E, Botta F, Borro P, Risso D, Romagnoli P, Fasoli A, et al. Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of esophageal varices in patients with liver cirrhosis. Gut. 2003;52:1200-5.

Hong SN, Kim JE, Cho ML, Heo YJ, Choi JH, Lee J, et al. Comparison of the Child-Turcotte-Pugh Classification and the Model for End-stage Liver Disease Score as Predictors of the Severity of the Systemic Inflammatory Response in Patients Undergoing Living-donor Liver Transplantation. J Korean Med Sci. 2011;26:1333-8.

Sharma SK, Aggarwal R. Prediction of large esophageal varices in patients with cirrhosis of the liver using clinical, laboratory and imaging parameters. J Gastroenterol Hepatol. 2007;22(11):1909-15.

Legasto GMA, Sevilla J, Balay A, Tan JA. Platelet count to spleen diameter ratio as a noninvasive parameter to predict the presence of esophageal varices. Phil J Gastroenterol. 2006;2:33-8.

Baig WW, Nagaraja MV, Varma M, Prabhu R, et al. Platelet count to spleen diameter ratio for the diagnosis of esophageal varices: Is it feasible? Can J Gastroenterol. 2008;22(10):825-8.

Sarangapani A, Shanmugam C, Kalyanasundaram M, Rangachari B, Thangavelu P, Subbarayan KJ. Noninvasive prediction of large esophageal varices in chronic liver disease patients. Saudi J Gastroenterol. 2010;16(1):38-42.

Cherian JV, Deepak N, Ponnusamy PR, Somasundaram A, Jayanthi V. Noninvasive predictors of esophageal varices. Saudi J Gastroenterol. 2011;17(1):64-8.

Barrera F, Riquelme A, Soza A. ‘Platelet count/spleen diameter ratio for non-invasive prediction of high risk esophageal varices in cirrhotic patients. Ann Hepatol. 2009;8(4):325.

Schwarzenberger E, Meyer T, Golla V, Sahdala NP, Min AD, et al. Utilization of Platelet Count /Spleen Diameter Ratio in Predicting the Presence of Esophageal Varices in Patients With Cirrhosis. J Clin Gastroenterol. 2010;44:146-50.

Abu El Makarem MA, Shatat ME, Shaker Y, Abdel Aleem AA, El Sherif AM, Moaty MA, Abdel Ghany HS, Elakad A, Kamal Eldeen AM. Platelet count/bipolar spleen diameter ratio for the prediction of esophageal varices: The special Egyptian situation: Non-invasive prediction of esophageal varices. Hepato Mon. 2011;11(4):278-84.

Tafarel JR, Tolentino LH, Correa LM, Bonilha DR, Piauilino P, Martins FP, Rodrigues RA, Nakao FS, Libera ED, Ferrari AP, da Silveira Röhr MR. Prediction of esophageal varices in hepatic cirrhosis by noninvasive markers. Eur J Gastroenterol Hepatol. 2011;23(9):754-8.

Mattos AZ, Mattos AA, Vianna FF, Musskopf MI, Pereira-Lima JC, Maciel AC. Platelet count/spleen diameter ratio: analysis of its capacity as a predictor of the existence of esophageal varices. Arq Gastroenterol. 2010;47(3):275.