Platelet count/splenic diameter ratio: a noninvasive method for diagnosis of esophageal varices in Egyptian cirrhotic patients

Abstract

Aim/Objectives To assess the utility of of platelet count (PC)/ SD ratio as a noninvasive predictor of EV. Background Bleeding esophageal varices (EV) remain a leading cause of death in cirrhotic Egyptian patients. Although current guidelines recommend screening for EV, repeated endoscopies cause a significant burden and cost to endoscopy units and may expose patients to unnecessary procedures. Methods This prospective cross-sectional analytic study included 100 Egyptian patients with liver cirrhosis, where splenic diameter assessment by ultrasound and upper endoscopy for grading of EV were done. Results We found that the mean platelet count (PL) in patients with varices is 103 300±25 520/ml, whereas in patients with no varices is 212 390±58 980/ml. The mean spleen diameter (SD) in patients with varices is 154.59±10.57 mm, whereas in patients with no varices is 140.14±8.74 mm. The mean PL/SD ratio in patients with varices is 668.22±169.10 whereas in patients with no varices is 1515.56±470.40. The three relations werehighly significant (P≤0.00). At a cutoff value of 909, PL/SD showed sensitivity of 82.81% and specificity of 91.67%, with diagnostic accuracy of 89.8%. Conclusions In conclusion, the use of PC/SD ratio can be of help to the physicians as a noninvasive predictor of EV to restrict the use of endoscopic screening only to patients presenting a high probability of EV. This is especially useful in clinical settings where resources are limited and endoscopic facilities are not present in all areas.