Diagnostic Accuracy of Platelet Count to Spleen Size for Prediction of Esophageal Varices in Patients of Liver Cirrhosis
Keywords:
Diagnostic accuracy, Esophageal varices, Liver cirrhosis, Platelet count, Spleen size, Ratio of platelet count to spleen sizeAbstract
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.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2016 Mashkoor Ahmad, Faran Nasrullah, Abdul Qayyum, Rashid Mahmood
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Journal of Bahria University Medical & Dental College is an open access journal and is licensed under CC BY-NC 4.0. which permits unrestricted non commercial use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0