A Study on Platelet Count-Splenic Diameter Ratio as a Non-Invasive Predictor of Oesophageal Varices in Cirrhosis

BACKGROUND AND OBJECTIVE: Cirrhosis is a common disease which has significant morbidity and it is one of the cause for premature mortality. The major complication of cirrhosis is portal hypertension which in turn leads to variceal bleeding which accounts for 35-40% mortality. In patients with chronic liver disease, endoscopic screening for esophageal varices (EV) is currently recommended in all patients at the time of diagnosis of cirrhosis. In order to improve the compliance of patients and to reduce the burden on physicians and hospitals, invasive procedures to diagnose the incidence of oesophageal varices need to be avoided and replaced with simple and easily available and reproducible investigation/screening. This study is done to analyse the predictive value in the diagnosis of Oesophageal varices in patient with Cirrhosis with a non-invasive parameter like Platelet count Splenic Diameter ratio. METHODS: The study included 75 patients admitted in Government Rajaji Hospital, Madurai with Cirrhosis in the period between September 2013 to August 2014. Cirrhosis was diagnosed with the help of history, clinical examination and ultrasonogram. All 75 patients underwent Ultrasonogram (for splenic diameter) and platelet count was done. The following patients were included viz… 1. Age > 18 years/ Males. 2. Patients undergoing screening endoscopy for varices at the time of diagnosis of cirrhosis. 3. Known cirrhotic patients who have never undergone screening endoscopy for EV. Patients with 1. Active upper G.I.bleeding, 2. Previous history of endoscopic sclerosis / band ligation of EV, 3. Previous surgery for portal hypertension (stents), 4. Previous history of Beta Blocker treatment / prophylaxis, 5. Inabilty to abstain from alcoholism were excluded from the study. The data and variables collected from the patients were compiled and analysed with statistical methods (Chi square). RESULTS AND INTERPRETATION: Among the 75 patients, a total of 50 patients had esophageal varices on upper gastrointestinal endoscopy. Out of these, 48 patients had a platelet count/splenic diameter 909. A total of 54 patients in the study had a ratio of <909 in the study. Varices were absent in 4 of them. The mean platelet count spleen diameter ratio of patients with out varices was 961.98 and the mean platelet count spleen diameter ratio of patients with varices was 689.62. Hence, using a ratio of 909 as cutoff, 96% of patients with varices were detected (sensitivity-96% and specificity-90.48%). The P value <o.oo7 which is more significant than using a single parameter. The positive predictive value is 88% and the negative predictive value is 90.4%. CONCLUSION: Lower the platelet count spleen size ratio, higher the incidence of varices and higher the grades. This study conclude that presence of a lower PC/SD ratio determine the presence of varices and hence identify the subset of patients who require endoscopy for the prophylactic management of esophageal varices. Apart from being noninvasive, platelet count, spleen bipolar diameter and the PC/SD ratio is a relatively inexpensive test.