Rizvi Syed Rohail Ahmed, Wallam Muhammad Danish Ashraf, Siddiqui Arif Rasheed, Haqqi Syed Afzal Ul Haq, Farrukh Zea Ul Islam, Niaz Saad Khalid, Farooq Muhammad Umar, Kakar Fahad, Hashmi Atif A
Gastroenterology, Patel Hospital, Karachi, PAK.
Pathology, Liaquat National Hospital and Medical College, Karachi, PAK.
Cureus. 2024 May 4;16(5):e59627. doi: 10.7759/cureus.59627. eCollection 2024 May.
Introduction Esophageal variceal bleeding is a potentially deadly consequence of portal hypertension in patients with cirrhosis. Although upper gastrointestinal endoscopy is still the preferred method for identifying esophageal varices (EV), the present study measured the platelet count to prothrombin time (PLT/PT) ratio for the assessment of portal hypertension and subsequent diagnosis of EVs in patients with chronic liver disease (CLD). Methods This was an observational comparative study conducted in the outpatient department of Patel Hospital, Karachi, Pakistan, using a non-probability consecutive sampling technique. Ethical approval was obtained from the Patel Hospital ethical review committee (PH/IRB/2022/028). An independent sample t-test was used for parametric data, whereas the Mann-Whitney U test was used for non-parametric data. The chi-square test was used to compare the categorical data of patients with and without EV. Receiver operating characteristic (ROC) analysis was performed to evaluate the cutoff values for the PLT/PT ratio, sensitivity, specificity, and area under the curve (AUC). Results The study involved 105 patients with and without EV. Among them, 38 (63.3%) males and 22 (36.7%) females had EV, whereas 30 (66.7%) males and 15 (33.3%) females did not. The platelet (PLT) count was also significantly lower in patients with EV (87.6 ± 59.8) than in those without (176.6 ± 87.7) (p < 0.001). The PLT/PT ratio was significantly lower in patients with EV (median: 5.04, IQR: 3.12-9.21) compared to those without (median: 14.57, IQR: 8.08-20.58) (p < 0.001). The sensitivity and specificity of the PLT/PT ratio for identifying EVs were 97.80% and 83.30%, respectively. Conclusion We found a significantly lower PLT/PT ratio in cases with EV than those without EV. After defining an optimal cutoff, PLT/PT had a high sensitivity in identifying cases with EVs in CLD. Therefore, we conclude that in patients with CLD, the PLT/PT ratio is a noninvasive predictor for the presence of EV.
引言 食管静脉曲张破裂出血是肝硬化患者门静脉高压潜在的致命后果。虽然上消化道内镜检查仍是识别食管静脉曲张（EV）的首选方法，但本研究通过测量血小板计数与凝血酶原时间（PLT/PT）的比值来评估门静脉高压，并对慢性肝病（CLD）患者进行EV的后续诊断。
方法 本研究在巴基斯坦卡拉奇帕特尔医院门诊部采用非概率连续抽样技术进行观察性比较研究。获得了帕特尔医院伦理审查委员会（PH/IRB/2022/028）的伦理批准。参数数据采用独立样本t检验，非参数数据采用曼-惠特尼U检验。采用卡方检验比较有和没有EV患者的分类数据。进行受试者操作特征（ROC）分析以评估PLT/PT比值的临界值、敏感性、特异性和曲线下面积（AUC）。
结果 该研究纳入了105例有和没有EV的患者。其中，有EV的患者中男性38例（63.3%），女性22例（36.7%）；没有EV的患者中男性30例（66.7%），女性15例（33.3%）。有EV的患者血小板（PLT）计数（87.6±59.8）也显著低于没有EV的患者（176.6±87.7）（p<0.001）。与没有EV的患者相比，有EV的患者PLT/PT比值显著更低（中位数：5.04，四分位间距：3.12 - 9.21）（中位数：14.57，四分位间距：8.08 - 20.58）（p<0.001）。PLT/PT比值识别EV的敏感性和特异性分别为97.80%和83.30%。
结论 我们发现有EV的病例中PLT/PT比值显著低于没有EV的病例。确定最佳临界值后，PLT/PT在识别CLD中有EV的病例方面具有高敏感性。因此，我们得出结论，在CLD患者中，PLT/PT比值是EV存在的无创预测指标。
