Diagnostic Accuracy of Platelet Count to Spleen Size for Prediction of Esophageal Varices in Patients of Liver Cirrhosis

Authors

  • Mashkoor Ahmad
  • Faran Nasrullah
  • Abdul Qayyum
  • Rashid Mahmood

Keywords:

Diagnostic accuracy, Esophageal varices, Liver cirrhosis, Platelet count, Spleen size, Ratio of platelet count to spleen size

Abstract

Objective: To determine the diagnostic accuracy of ratio of platelet count to spleen size for prediction of esophageal varices
in patients of liver cirrhosis, keeping upper GI endoscopy as gold standard.
Materials and Methods: This cross-sectional validation study was carried out in Radiology Department, Combined Military
Hospital, Peshawar from February, 2015 to August, 2015.One hundred and fifty patients of either sex, having liver cirrhosis
with no episode of gastrointestinal bleeding, scheduled to undergo upper GI endoscopy were selected.Ultrasound abdomen of
these patients was carried out and spleen size was determined in millimeters. Platelet count if already not performed was also
carried out.Platelet count was divided by the spleen size to obtain the platelet count to spleen size ratio. Close follow up of the
patient was done until he/she underwent upper GI endoscopy for diagnosis of esophageal varices. A correlation was performed
between the platelet count to spleen size ratio and findings of upper GI endoscopy.
Results: Collected data was analyzed through computer software SPSS11.0.The ratio of platelet count to spleen size as a
predictor of esophageal varices in patients of liver cirrhosis demonstrated sensitivity of 92.5 %, specificity of 87.5 %, positive
predictive value of 93.3 %, negative predictive value of 86.1 % and diagnostic accuracy of 90.8 %.
Conclusion: The ratio of platelet count to spleen size as a predictor of esophageal varices in patients of liver cirrhosis is found
to be high

References

Sarangapani A, Shanmugam C, Kalyanasundaram M,

Rangachari B, Thangavelu P, Subbarayan JK. Noninvasive

prediction of large esophageal varices in chronic

liver disease patients. Saudi J Gastroenterol 2010;16:38-

Muhammad SK, Shah IA, Shaikh MA. Serological,

radiological and biochemical profile of cirrhotic patients

with and without esophageal varices. Rawal Medical

Journal 2012;37(4):377-82.

D'Amico G1, Garcia-Tsao G, Pagliaro L. Natural history

and prognostic indicators of survival in cirrhosis: a

systematic review of 118 studies. J Hepatol 2006 Jan;44

(1):217-3.

D’Amico G, de Franchis R, Cooperative Study Group

Upper digestive bleeding in cirrhosis. Post-therapeutic

outcome and prognostic indicators. Hepatology 2003;38:

-612.

Chalasani N, Kahi C, Francois F. Improved patient

survival after acute variceal bleeding: A multicenter,

cohort study. Am J Gastroenterol 2003;98:653-9.

Carbonell N, Pauwels A, Serfaty L. Improved survival

after variceal bleeding in patients with cirrhosis over

the past two decades. Hepatology 2004;40:652-9.

Di Fiore F, Lecleire S, Merle V.Changes in characteristics

and outcome of acute upper gastrointestinal haemorrhage:

A comparison of epidemiology and practices between

and 2000 in a multicentre French study. Eur J

Gastroenterol Hepatol 2005;17:641-7.

Mattos AZ, Mattos AA, Vianna FF, Musskopf MI,

Pereira-Lima JC, Maciel AC. Platelet count/spleen

diameter ratio: analysis of its capacity as a predictor of

the existence of esophageal varices. Arq Gastroenterol

;47:275-8.

Garcia-Tsao G, Sanyal AJ, Grace ND, Carey WD;

Practice Guidelines Committee of the American

Association for the Study of Liver Diseases; Prevention

and management of gastroesophageal varices and variceal

hemorrhage in cirrhosis. Am J Gastroenterol 2007;102(9):

-102.

Kovalak M, Lake J, Mattek N, Eisen G, Lieberman D,

Zaman A. Endoscopic screening for varices in cirrhotic

patients: Data from a national endoscopic database.

Gastrointest Endosc 2007;65:82-8.

Dib N, Konate A, Oberti F, Calès P. Non-invasive

diagnosis of portal hypertension in cirrhosis. Application

to the primary prevention of varices. Gastroenterol Clin

Biol 2005;29:975-87.

Qamar AA, Grace ND, Groszmann RJ. Portal Hypertension

Collaborative Group Platelet count is not a predictor

of the presence or development of gastroesophageal

varices in cirrhosis. Hepatology 2008;47:153-9.

Giannini E, Botta F, Borro P, Risso D, Romagnoli P,

Fasoli A, et al. Platelet count/spleen diameter ratio:

proposal and validation of a non-invasive parameter to

predict the presence of oesophageal varices in patients

with liver cirrhosis. Gut 2003 Aug; 52(8):1200-5.

Gibson PR, Gibson RN, Ditchfield MR, Donlan JD.

Splenomegaly--an insensitive sign of portal hypertension.

AustN Z J Med 1990 Dec; 20(6):771-4.

Pilette C, Oberti F, Aubé C, Rousselet MC, Bedossa P,

Gallois Y, et al. Non-invasive diagnosis of esophageal

varices in chronic liver diseases. J Hepatol 1999

Nov;31(5):867-73.

González-Ojeda A, Cervantes-Guevara G, Chávez-

Sánchez M, Dávalos-Cobián C, Ornelas-Cázares S,

Macías-Amezcua MD et al. Platelet count/spleen

diameter ratio to predict esophageal varices in Mexican

patients with hepatic cirrhosis. World J Gastroenterol

;20(8):2079-84.

González-Navajas JM. Inflammasome activation in

decompensated liver cirrhosis. World J Hepatol 2016;

(4):207-10.

Groszmann RJ, Abraldes JG. Portal hypertension: from

bedside to bench. J Clin Gastroenterol 2005;39(4 Suppl

:S125-30.

Poca M, Puente A, Graupera I, Villanueva C. Prognostic

markers in patients with cirrhosis and portal hypertension

who have not bled. Dis Markers 2011;31:147-54.

Abu El Makarem MA, Shatat ME, Shaker Y, Abdel

Aleem AA, El Sherif AM, Abdel Moaty M, et al. Platelet

count/bipolar spleen diameter ratio for the prediction of

esophageal varices: The special Egyptian situation:

Noninvasive prediction of esophageal varices. Hepat

Mon 2011;11(4):278-84.

Baig WW, Nagaraja MV, Varma M, Prabhu R. Platelet

count to spleen diameter ratio for the diagnosis of

esophageal varices: Is it feasible? Can J Gastroenterol

; 22(10): 825-8.

Nisar S, Nazir S, Butt A, Hussain A, Yousaf KR. Validity

of Platelet Count/Spleen Diameter Ratio for the Noninvasive

Diagnosis of Esophageal Varices in Cirrhotic

Amin K, Muhammad D, Anjum A, Jamil K, Ali Hassan.

Platelet count to spleen diameter ratio as a predictor of

esophageal varices in patients of liver cirrhosis due to

hepatitis C virus JUMDC 2012; 3(1):6-11.

Sarwar S, Alam A, Khan AA, Butt AK, Shafqat F, Shah

WH et al. Platelet count/splenic size ratio: Can it predict

the presence of varices in patients of Cirrhosis of liver?

Proceeding Shaikh Zayed Postgrad Med Inst 2004; 18:

-6.

Legasto GMA, Sevilla J, Balay A, Tan JA, Cham LV,

Vitug A, et al. Platelet count/ spleen diameter ratio: A

noninvasive parameter to predict the presence of

esophageal varices. Phil J Gastroenterol 2006; 2: 33-8.

Giannini EG, Zaman A, Kreil A, Floreani A, Dulbecco

P, Testa E, et al. Platelet count/spleen diameter ratio for

the noninvasive diagnosis of esophageal varices: results

of a multicenter, prospective, validation study. Am J

Gastroenterol 2006; 101: 2511-9.

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Published

2016-09-14

How to Cite

Ahmad, M. ., Nasrullah, F. ., Qayyum, A. ., & Mahmood, R. . (2016). Diagnostic Accuracy of Platelet Count to Spleen Size for Prediction of Esophageal Varices in Patients of Liver Cirrhosis. Journal of Bahria University Medical and Dental College, 6(3), 151–155. Retrieved from https://jbumdc.bahria.edu.pk/index.php/ojs/article/view/187

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