Objective: To assess validity of platelet count/spleen diameter ratio in cirrhotic patients, as a non-invasive predictor of high risk esophageal varices (EVs).
Study Design: Cross sectional validation study.
Place and Duration of Study: Department of Medicine, Military Hospital Rawalpindi.
Material and Methods: A total of 160 cases with cirrhosis due to any cause were included in this study. The study included both male and female subjects and was restricted to age 35-70 years. Exclusion criteria were also applied to this group of patients. All these patients underwent blood test for platelet count and ultrasound abdomen for splenic diameter. For each patient calculation of platelet/splenic ratio was determined with a cut off value of 909 determined. Values greater than this cut off were supposed not to have high risk esophageal varices. Upper gastrointestinal endoscopies were performed on all patients and then on the basis of endoscopy results the patients were divided into two groups, first group in which high risk EVs (grade 2 and grade 3) were present and second group in which they were absent. Subsequently sensitivity, specificity, predictive values and accuracy were calculated, keeping in view the calculated cut off value and endoscopy findings.
Results: In our study, 60% (n=96) were between 35-50 years of age and 40% (n=64) were between 51-70 years of age, mean ± SD was calculated as 50.15 ± 9.28 years, 55.63% (n=89) were male and 44. 37% (n=71) were females. Validity of platelet count/spleen diameter ratio in cirrhotic patients for diagnosis of high risk EVs, keeping endoscopy as gold standard was recorded which showed that 58.13% (n=93) were true positive, 5.63% (n=9) were false positive, 27.5% (n=44) were true negative and 8.75% (n=14) were false negative. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate were calculated as 86.92%, 83.01%, 91.18%, 75.86% and 85.63% respectively.
Conclusion: Our results suggest that the platelet count/spleen diameter ratio may be a useful tool for detecting EVs in patients with hepatic cirrhosis but some-other trials in our local population are required to further authenticate its accuracy.
Cirrhosis, High risk esophageal varices, Platelet count/spleen diameter ratio.