Vmmc and Sjh, New Delhi.
J Assoc Physicians India. 2022 Apr;70(4):11-12.
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.
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.
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%.
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.
本研究旨在确定血小板计数/脾长比值作为食管静脉曲张非侵入性预测因子的有效性。
进行了一项观察性横断面研究，纳入了 52 例无既往上消化道出血史的肝硬化患者。评估了包括全血细胞计数、上消化道内镜和脾脏长度超声测量在内的相关临床参数。将患者分为两组，一组有食管静脉曲张，另一组无食管静脉曲张。比较了这两组之间的血小板计数/脾长比值。
研究人群中 65.38%的患者有食管静脉曲张。在食管静脉曲张组和非静脉曲张组中分别观察到以下结果：平均脾脏长度为 156.26 ± 13.64mm 和 126.06 ± 6.40mm（p<0.001），平均血小板计数为 102882 ± 20188/mm3 和 156000 ± 36378 mm3（p<0.001），血小板计数/脾长比值为 672.82 ± 188.06 和 1243.55 ± 307.53（p<0.001）。发现血小板计数/脾长比值 <926 预测静脉曲张的敏感性为 91%，特异性为 78%。
血小板计数/脾长比值可用于预测食管静脉曲张，并识别需要内镜检查预防性管理静脉曲张出血的患者亚组。因此，为了减轻内镜单位的负担，避免不必要的筛查性内镜检查。
