Platelet Count/Splenic Diameter Ratio: A Non Invasive Method for Diagnosis of Oesophageal Varices in Cirrhotic Patients

Abstract

Summary he development of esophageal varices is one of the major complications of portal hypertension, which is considered a main complication of liver cirrhosis. Variceal bleeding occurs in 20–40% of cirrhotic patients with esophageal varices and the current guidelines recommend screening all liver cirrhosis patients by endoscopy. Endoscopic screening of all patients with liver cirrhosis would result in a large number of unnecessary endoscopies and additional burden to endoscopic units and also repeated endoscopic examinations are unpleasant for the patients. We conducted this study to prospectively evaluate the possibility of using platelet count/spleen diameter ratio as a noninvasive predictor of esophageal varices in patients with liver cirrhosis. This prospective study included one hundred patients with liver cirrhosis. All studied subjects underwent a detailed clinical examination, biochemical workup, upper gastrointestinal endoscopy and abdominal ultrasound. The platelet count/spleen diameter ratio for all patients was calculated. In our study, Platelet count/spleen diameter ratio demonstrated a high statistically significant difference T  Summary and Conclusion 125 between patients with varices and those with no varices as The mean of PL/SD ratio in patients with varices was 668.2±169.1 while in patients with no varices was 1515.5±470.4, And according to sensitivity and specificity test PC / SD ratio is accurate screening test for diagnosis of esophageal varicose as AUC (89.8%), also it is a good negative test as specificity was (91.6%) with cutoff value (909). In our study, Grades of varices show statistically significant difference (P value<0.001) between ascitic and non-ascitic patients as in non ascitic patients 80%of patiens had no varices, While in ascitic patients 38.5% had grade IV varices and 31.4% of them had grade II varices. Grades of varices show statistically significant difference (P value<0.001) in patients with history of encephalopathy compared to patients with no history of encephalopathy as 50% of patients with history of encephalopathy had OV grade IV, While 47.1% of patients without history of encephalopathy had no varices Also, Grades of varices shows statistically significant difference (P value<0.001) between Child Pugh classes as in class A, 91.7% showed no varices,while in class B 41.9% showed grade II OV. In contrast patients in class C showed grade IV in 57.8%.