Title: Platelet Count to Spleen Diameter Ratio to Predict Esophageal Varices in Patients with Hepatic Cirrhosis
Authors: Dr S. Kondal Reddy MD, Dr Md Azhar Hussain MD
DOI: https://dx.doi.org/10.18535/jmscr/v6i10.159
Abstract
Introduction: The prevalence of esophageal varices in patients with liver cirrhosis may range from60% to 80%, and the reported mortality from variceal bleeding ranges from 17% to 57%In cirrhosis patients the risk of variceal rupture is greatest in the 2 years following diagnosis. Repeated endoscopy is required to predict the risk of variceal rupture which increases the burden of endoscopy procedures. Hence, Clinical and laboratory variables were used in various studies but platelet count/spleen diameter ratio had the highest accuracy for identifying patients with esophageal varices.
Aim and Objective: To for diagnosing esophageal varices (EVs) in Liver Cirrhosis. study the value of platelet count to spleen diameter ratio as a non invasive parameter
Patients and Methods: 100 patients diagnosed previously or newly, as cirrhosis of liver, based on physical examination, biochemical parameters, ultrasound abdomen and upper GI endoscopy in departments of General Medicine and Gastroenterology at a tertiary care hospital. All patients underwent biochemical tests, like liver function tests, complete blood counts, renal function tests, prothrombin time, ultrasonography of the abdomen to confirm the presence of cirrhosis, to record the spleen bipolar diameter, portal veinsize, ascites and presence of collaterals followed by Ascitic fluid analysis Upper GI endoscopy was done to confirm the presence of varices and grade them.
Results: Mean age of the patients in the study was 42.69.
No significant gender difference noted. Grade III varices predominated (27 %). Varices were absent (Grade 0) in 17 % of the patients. Among the non invasive markers only Platelet Count (P=0.0001) and Spleen Bipolar diameter (P=0.0002) had statistical significance. Significance was noted between Portal vein size(cm) and presence of Varices in the study group and statistically significant correlation between presence of varices and a platelet count/ splenic bipolar diameter ratio of≤1014. The sensitivity of PC/SD Ratio of ≤ 1014 in predicting presence of esophageal varices was 92.77 %.Its positive predictive value is 92.77 %.
Conclusions: The use of Platelet count/ Splenic diameter ratio, a non invasive parameters in appropriate subgroups of cirrhotic patients for screening and follow up of esophageal varices can reduce the cost of health care and discomfort for patients and burden on endoscopy units.
References
- Chalasani N, Imperiale TF, Ismail A, et al.(1999) Predictors of large esophageal varices in patients with cirrhosis. American Journal Of Gastroenterology, 94:3285–91
- Giannini E, Botta F, Borro P, Risso D, Romagnoli P, Fasoli A, Mele M R,Testa E,7171 Mansi C, Savarino V, Testa R.(2003) Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of esophageal varices inpatients with liver cirrhosis.Gut,52:1200-1205.
- Gurubacharya DL, Mathura KC, Karki DB.(2005) Correlation between serum ascites albumin concentration gradient and endoscopic parameters of portal hypertension. Katmandu University Medical Journal (KUMJ),3(12):327-33.
- Madhotra R, Mulcahy HE, Willner I, et al.(2002) Prediction of esophageal varices in patients with cirrhosis, Journal Of Clinical Gastroenterology,34:81–5.
- Pilette C, Oberti F, Aubé C, et al.(1999) Non-invasive diagnosis of esophageal varices in chronic liver disease. Journal Of Hepatology,31:867–73.
- Thomopoulos K C, Labropoulou-Karatza C, Mimidis K P, Katsakoulis E C, Iconomou G, Nikolopoulou V N.(2003) Non invasive predictors of the presence of large esophageal varices in patients with cirrhosis. Digestive and liverdisease, 35(7):473-78.