Prediction severity of esophageal varices: a new cutoff point for Platelet count/ spleen diameter ratio

Abstract

Aim: It is currently recommended that all patients with liver cirrhosis undergo upper gastrointestinal endoscopy (UGIE) to identify those who have esophageal varices (EV) that carry a high risk of bleeding and may benefit from prophylactic measures. In the future, this social and medical burden will increase due to the greater number of patients with chronic liver disease and their improved survival. The aim of this paper was assess value of platelet count/spleen diameter ratio (PC/SD ratio) for the prediction or screening of EV in cirrhotic patients.

Methods: In this two years prospective study, patients with liver cirrhosis referred to Al -Zahra hospital enrolled. Patients underwent detailed clinical examination, blood tests (hematology, liver function tests) and ultrasonography. Size of esophageal varices was assessed at UGIE; Paquet's grades 0-III were classified as group A (0-I; No or Mild EV) and group B (II-III; Moderate to severe EV). PC/SD ratio was also measured as possible noninvasive predictive/screening tools. Degree of eEV was assessed at UGIE. The relationship of the presence and degree of EVs with PC/SD ratio was evaluated.

Results: Fifty consecutive cirrhotic patients (mean age+/-SD) was 52.1 (+/-16.2); 41 male and 9 female) were enrolled; nineteen 19 (38%) patients were placed in group A (No or mild EV) while 31 (62%) had endoscopic evidence of moderate to severe EV (group B). PC/SD ratio cut off value of 921 had 93% negative predictive value. PC/SD ratio found to be significantly (P<0.05) different between group of A and B.

Conclusions: The PC/SD ratio is independently associated with the presence of EV and can predict its severity in patients with cirrhosis. Use of this cost effective parameter may help identify patients with mild or no EV who may not need UGIE to reduce costs and discomfort for these patients and the burden on health system.