Giannini Edoardo G, Zaman Atif, Kreil Anna, Floreani Annarosa, Dulbecco Pietro, Testa Emanuela, Sohaey Roya, Verhey Peter, Peck-Radosavljevic Markus, Mansi Carlo, Savarino Vincenzo, Testa Roberto
Department of Internal Medicine, University of Genoa, Genoa, Italy.
Am J Gastroenterol. 2006 Nov;101(11):2511-9. doi: 10.1111/j.1572-0241.2006.00874.x. Epub 2006 Oct 4.
Noninvasive assessment of esophageal varices (EV) may improve the management of patients with cirrhosis and decrease both the medical and financial burden related to screening. In this multicenter, international study, our aim was to prospectively validate the use of the platelet count/spleen diameter ratio for the noninvasive diagnosis of EV.
A total of 218 cirrhotic patients underwent screening endoscopy for EV. Platelet count/spleen diameter ratio ((N/mm3)/mm) was assessed in all patients and its diagnostic accuracy was calculated. On the basis of previous results, a platelet count/spleen diameter ratio cutoff of 909 was applied to this population. The diagnostic accuracy of the platelet count/spleen diameter ratio was further evaluated for both severity and etiology of disease subgroups.
Prevalence of EV was 54.1%. The platelet count/spleen diameter ratio had 86.0% (95% CI, 80.7-90.4%) diagnostic accuracy for EV, which was significantly greater as compared with either accuracy of platelet count alone (83.6%, 95% CI 78.0-88.3%, P= 0.038) or spleen diameter alone (80.2%, 95% CI 74.3-85.3%, P= 0.018). The 909 cutoff had 91.5% sensitivity (95% CI 85.0-95.9%), 67.0% specificity (95% CI 56.9-76.1%), 76.6% positive predictive value, 87.0% negative predictive value, 2.77 positive likelihood ratio, and 0.13 negative likelihood ratio for the diagnosis of EV. Accuracy of the platelet count/spleen diameter ratio was maintained for both severity and etiology of disease subgroups.
The platelet count/spleen diameter ratio may be proposed as a safe and reproducible means to improve the management of cirrhotic patients who should undergo screening endoscopy for EV.
食管静脉曲张（EV）的无创评估可能改善肝硬化患者的管理，并减轻与筛查相关的医疗和经济负担。在这项多中心国际研究中，我们的目的是前瞻性验证血小板计数/脾直径比值用于EV无创诊断的效用。
共有218例肝硬化患者接受了EV筛查内镜检查。评估了所有患者的血小板计数/脾直径比值（（每立方毫米）/毫米），并计算其诊断准确性。根据先前的结果，将血小板计数/脾直径比值临界值909应用于该人群。进一步评估了血小板计数/脾直径比值在疾病亚组的严重程度和病因方面的诊断准确性。
EV的患病率为54.1%。血小板计数/脾直径比值对EV的诊断准确性为86.0%（95%CI，80.7 - 90.4%），与单独血小板计数的准确性（83.6%，95%CI 78.0 - 88.3%，P = 0.038）或单独脾直径的准确性（80.2%，95%CI 74.3 - 85.3%，P = 0.018）相比，显著更高。909临界值对EV诊断的敏感性为91.5%（95%CI 85.0 - 95.9%），特异性为67.0%（95%CI 56.9 - 76.1%），阳性预测值为76.6%，阴性预测值为87.0%，阳性似然比为2.77，阴性似然比为0.13。血小板计数/脾直径比值的准确性在疾病亚组的严重程度和病因方面均得以维持。
血小板计数/脾直径比值可作为一种安全且可重复的方法，用于改善应对EV应接受筛查内镜检查的肝硬化患者的管理。
