Correlation Of Platelet Count/Splenic Diameter Ratio For The Diagnosis Of Esophageal Varices In Patients Of Cirrhosis Of Liver

Abstract

BACKGROUND AND OBJECTIVES In patients with cirrhotics, Endoscopic screening for esophageal varices is currently recommended as a gold standard tool in all the patients at the time of diagnosis of cirrhosis and to institute prophylactic measures in patients with large esophageal varices. In order to reduce the increasing burden that endoscopy units will have to bear, new methods have been proposed as alternatives to conventional endoscopy for the non-invasive or minimally invasive diagnosis of esophageal varices. In this study we aimed at identifying non invasive parameters especially platelet count, splenic diameter and platelet count/spleen diameter ratio that could predict the presence of esophageal varices. METHODOLOGY The present one year observational study was done in the Department of General Medicine at KLES Dr Prabhakar kore Hospital and Medical Research Centre Belagavi. A total of 70 patients with cirrhosis of liver were included in the study. Patients were subjected to relevant clinical examination, laboratory workup like complete blood count, liver function test, ultrasound abdomen and all patients underwent screening upper gastrointestinal endoscopy. Platelet count to spleen diameter ratio was calculated for all patients. RESULTS Among 70 patients of cirrhosis 54(77.14%) had varices. Males predominated with 64(91%). Majority patients ranged in between 31-50 years. Evidence of esophageal varices was more common with cirrhosis secondary to alcoholism as compared to HBV, HCV. The Child Pugh score, platelet count, spleen size, platelet count/spleen diameter ratio in patients with varices was significantly different from patients without varices. Platelet count spleen diameter ratio cutoff value of 909 was obtained with sensitivity of 77% and specificity of 79%. The positive predictive value was 88% and negative predictive value was 62%. CONCLUSION AND INTERPRETATION There is strong evidence of correlation between platelet count, spleen diameter and platelet count/spleen diameter ratio for predicting esophageal varices in patients of cirrhosis. But platelet count/spleen diameter ratio with cut-off value of 909 may not be sufficiently accurate. The platelet count to spleen diameter ratio may be useful inexpensive tool for diagnosing esophageal varices in liver cirrhosis noninvasively when endoscopy facilities are not available.