Platelet Count/Spleen Length Ratio to Predict the Presence of Esophageal Varices in Patients with Cirrhosis.

UNLABELLED

Esophageal variceal bleeding remains the leading cause of acute mortality in patients with cirrhosis. As per guidelines, upper gastrointestinal screening endoscopy is recommended for all patients with cirrhosis to rule out esophageal varices. However, only 50% of newly diagnosed patients with cirrhosis have Esophageal varices. Hence there is a need for non-invasive parameters to predict the presence of esophageal varices to restrict the endoscopic studies to those with a high probability of having varices. In this study, we aimed to identify the effectiveness of Platelet Count/Spleen Length Ratio as a non-invasive predictor of esophageal varices.

MATERIAL

An observational cross-sectional study was conducted including 52 patients with liver cirrhosis without a previous history of upper GI bleeding. Relevant clinical parameters were assessed including complete hemogram, upper GI endoscopy, and ultrasonographic measurement of spleen length. Patients were divided into two groups, one with esophageal varices and the other without esophageal varices. Platelet Count/Spleen Length Ratio was compared between these two groups.

OBSERVATION

Out of the study population 65.38% of the patients had Oesophageal varices. The following observations were made in oesophageal variceal group and non-variceal group respectively; Mean spleen length was 156.26 ± 13.64 mm and 126.06 ± 6.40 mm(p<0.001), mean platelet count was 102882 ± 20188/mm3 and 156000 ± 36378 mm3 (p<0.001), Platelet Count/Spleen Length Ratio was 672.82 ± 188.06 and 1243.55 ± 307.53 (p<0.001). Platelet Count/Spleen Length Ratio of <926 was found to have a sensitivity of 91% in predicting varices and the specificity was 78%.

CONCLUSION

Platelet Count/Spleen Length RATIO can be used as a predictor of esophageal varices and also to identify the subset of patients who require endoscopy for the prophylactic management of variceal bleeding. Therefore, to reduce the burden on the endoscopy units, avoiding unnecessary screening endoscopies.