A study of platelet count/ spleen diameter ratio as a predictor of esophageal varices in patients of cirrhosis
Keywords:
Cirrhosis, Esophageal varices, PC/SD ratio, Platelet count
Abstract
Background: Todays guidelines are clear that there are no substitute markers to determine the presence and size of esophageal varices, and endoscopy is still the only valid method to investigate varices.
Objective: To validate the PC/SD ratio as a predictor of the presence and absence of esophageal varices in patients with chronic hepatopathy.
Methodology: This study is an analytical cross-sectional validation study of a diagnostic test. The study was done in cases diagnosed of having hepatic cirrhosis by histology or physical, biochemical, and imaging examinations compatible with the disease and treatment from February 1, 2013 to December 31, 2014. Various hematological, biochemical and radiological work up was done.
Results: Of the total cases, 29(70.7%) had PC/SD ratio more than 909 and only 12(29.3%) had less than 909. The sensitivity of PC/SD ratio of 909 in predicting varix is 89.66% and specificity was 75%. Thus it can be considered a good and reliable tool for predicting varices.
Conclusion: The use of platelet count/ splenic diameter ratio in cirrhotic patients for screening and follow up for esophageal varices can substantially reduce the cost of health care and discomfort for patients as well as reduce burden of endoscopy unit.
Downloads
Download data is not yet available.
References
1. Fattovich G, Giustina G, Degos F, Tremolada F, Diodati G, Almasio P, Nevens F, Solinas A, Mura D, Brouwer JT, Thomas H, Njapoum C, Casarin C, Bonetti P, Fuschi P, Basho J, Tocco A, Bhalla A, Galassini R, Noventa F, Schalm SW, Realdi G. Morbidity and mortality in compensated cirrhosis type C: a retrospective follow-up study of 384 patients. Gastroenterology. 1997 Feb;112(2):463-72.
2. Gentilini P, Laffi G, La Villa G, Romanelli RG, Buzzelli G, Casini-Raggi V, Melani L, Mazzanti R, Riccardi D, Pinzani M, Zignego AL. Long course and prognostic factors of virus-induced cirrhosis of the liver. Am J Gastroenterol. 1997 Jan;92(1):66-72.
3. Rukhsana JF, Javed IF, Masood R et al. Outcome after injection sclerotherapy for esophageal variceal bleeding in patients with liver cirrhosis and COPD. J Postgrad Med Inst 2005; 19: 76-80.
4. Garcia-Tsao G, Sanyal AJ, Grace ND, Carey WD; Practice Guidelines Committee of American Association for Study of Liver Diseases; Practice Parameters Committee of American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Am J Gastroenterol. 2007 Sep;102(9):2086-102.
5. Pascal JP, Calès P, Desmorat H. Natural history of esophageal varices. In: Bosch J, Rodès J, editors. Recent advances in the pathophysiology and treatment of portal hypertension. Serono Symposia review no. 22. Rome, Italy: 1989: 127-142.
6. de Franchis R; Baveno V Faculty. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2010 Oct;53(4):762-8. doi: 10.1016/j.jhep.2010.06.004. Epub 2010 Jun 27.
7. Schepis F, Cammà C, Niceforo D, Magnano A, Pallio S, Cinquegrani M, D'amico G, Pasta L, Craxì A, Saitta A, Raimondo G. Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection? Hepatology. 2001 Feb;33(2):333-8. [PubMed]
8. Madhotra R, Mulcahy HE, Willner I, Reuben A. Prediction of esophageal varices in patients with cirrhosis. J Clin Gastroenterol. 2002 Jan;34(1):81-5. [PubMed]
9. Zein CO, Lindor KD, Angulo P. Prevalence and predictors of esophageal varices in patients with primary sclerosing cholangitis. Hepatology. 2004 Jan;39(1):204-10. [PubMed]
10. Zaman A, Becker T, Lapidus J, Benner K. Risk factors for the presence of varices in cirrhotic patients without a history of variceal hemorrhage. Arch Intern Med 2001; 161: 2564-2570.
11. Riggio O, Angeloni S, Nicolini G, Merli M, Merkel C. Endoscopic screening for esophageal varices in cirrhotic patients. Hepatology. 2002 Feb;35(2):501-2. [PubMed]
12. Giannini E, Botta F, Borro P, Risso D, Romagnoli P, Fasoli A, Mele MR, Testa E, Mansi C, Savarino V, Testa R. 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. [PubMed]
13. Giannini EG, Botta F, Borro P, Dulbecco P, Testa E, Mansi C, Savarino V, Testa R. Application of the platelet count/spleen diameter ratio to rule out the presence of oesophageal varices in patients with cirrhosis: a validation study based on follow-up. Dig Liver Dis. 2005 Oct;37(10):779-85. [PubMed]
14. Zimbwa TA, Blanshard C, Subramaniam A. Platelet count/spleen diameter ratio as a predictor of oesophageal varices in alcoholic cirrhosis. Gut. 2004 Jul;53(7):1055. [PubMed]
15. Andrew K Burroughs. The portal venous system and portal hypertension. Twelfth Edition. Wiley – Blackwell.2011.
16. D. Amico G, Luca A. Portal hypertension. Natural history. Clinical-hemodynamics correlation. Prediction of the risk of bleeding. Baillieres Clinical Gastroenterology 1 997;11:243-56.
17. Schepis F, Cammà C, Niceforo D, Magnano A, Pallio S, Cinquegrani M, D'amico G, Pasta L, Craxì A, Saitta A, Raimondo G. Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection? Hepatology. 2001 Feb;33(2):333-8.
18. Jijo V Cherian, Nandan Deepak, Rajesh Prabhu Ponnusamy, Aravindh Somasundaram, V Jayanti. Non-invasive predictors of esophageal varices. The Saudi Journal Of Gastroenterology 2011;17(1):64-68. [PubMed]
19. 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. 2008 Oct;22(10):825-8. [PubMed]
20. Abu El Makarem MA, Shatat ME, Shaker Y, Abdel Aleem AA, El Sherif AM, Moaty MA, Abdel Ghany HS, Elakad A, Kamal Eldeen AM. Platelet count/bipolar spleen diameter ratio for the prediction of esophageal varices: The special Egyptian situation: Noninvasive prediction of esophageal varices. Hepat Mon. Apr 1, 2011;11(4):278-84.
21. Tafarel JR, Tolentino LH, Correa LM, Bonilha DR, Piauilino P, Marlins FP, Rodrigues RA, Nakao FS, Libera ED, Ferrari AP, da Silveira Rohr MR. Prediction of esophageal varices in hepatic cirrhosis by noninvasive markers. Eur J Gastroenterol Hepatol. Sep 2011;23(9):754-8.
22. Mangone M, Moretti A, Alivemini F, Papi C, Oretlce R, Dezi A, Amadei E, Aratai A, Bianchi M, Tornatore V, Koch M. Platelet count/spleen diameter ratio for non-invasive diagnosis of oesophageal varices: Is it useful in compensated cirrhosis? Dig Liver Dis.2012; 44(6):504-507.
23. de Franchis R. Noninvasive diagnosis of esophageal varices: is it feasible? Am J Gastroenterol. 2006 Nov;101(11):2520-2. [PubMed]
24. Peck-Radosavljevic M. Thrombocytopenia in liver disease. Can J Gastroenterol. 2000 Nov;14 Suppl D:60D-66D. [PubMed]
25. 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 Jan-Mar;16(1):38-42. doi: 10.4103/1319-3767.58767.
26. Chawla S, Katz A, Attar BM, Gupta A, Sandhu DS, Agarwal R. Platelet count/spleen diameter ratio to predict the presence of esophageal varices in patients with cirrhosis: a systematic review. Eur J Gastroenterol Hepatol. Apr 2012;24(4):431-6.
2. Gentilini P, Laffi G, La Villa G, Romanelli RG, Buzzelli G, Casini-Raggi V, Melani L, Mazzanti R, Riccardi D, Pinzani M, Zignego AL. Long course and prognostic factors of virus-induced cirrhosis of the liver. Am J Gastroenterol. 1997 Jan;92(1):66-72.
3. Rukhsana JF, Javed IF, Masood R et al. Outcome after injection sclerotherapy for esophageal variceal bleeding in patients with liver cirrhosis and COPD. J Postgrad Med Inst 2005; 19: 76-80.
4. Garcia-Tsao G, Sanyal AJ, Grace ND, Carey WD; Practice Guidelines Committee of American Association for Study of Liver Diseases; Practice Parameters Committee of American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Am J Gastroenterol. 2007 Sep;102(9):2086-102.
5. Pascal JP, Calès P, Desmorat H. Natural history of esophageal varices. In: Bosch J, Rodès J, editors. Recent advances in the pathophysiology and treatment of portal hypertension. Serono Symposia review no. 22. Rome, Italy: 1989: 127-142.
6. de Franchis R; Baveno V Faculty. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2010 Oct;53(4):762-8. doi: 10.1016/j.jhep.2010.06.004. Epub 2010 Jun 27.
7. Schepis F, Cammà C, Niceforo D, Magnano A, Pallio S, Cinquegrani M, D'amico G, Pasta L, Craxì A, Saitta A, Raimondo G. Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection? Hepatology. 2001 Feb;33(2):333-8. [PubMed]
8. Madhotra R, Mulcahy HE, Willner I, Reuben A. Prediction of esophageal varices in patients with cirrhosis. J Clin Gastroenterol. 2002 Jan;34(1):81-5. [PubMed]
9. Zein CO, Lindor KD, Angulo P. Prevalence and predictors of esophageal varices in patients with primary sclerosing cholangitis. Hepatology. 2004 Jan;39(1):204-10. [PubMed]
10. Zaman A, Becker T, Lapidus J, Benner K. Risk factors for the presence of varices in cirrhotic patients without a history of variceal hemorrhage. Arch Intern Med 2001; 161: 2564-2570.
11. Riggio O, Angeloni S, Nicolini G, Merli M, Merkel C. Endoscopic screening for esophageal varices in cirrhotic patients. Hepatology. 2002 Feb;35(2):501-2. [PubMed]
12. Giannini E, Botta F, Borro P, Risso D, Romagnoli P, Fasoli A, Mele MR, Testa E, Mansi C, Savarino V, Testa R. 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. [PubMed]
13. Giannini EG, Botta F, Borro P, Dulbecco P, Testa E, Mansi C, Savarino V, Testa R. Application of the platelet count/spleen diameter ratio to rule out the presence of oesophageal varices in patients with cirrhosis: a validation study based on follow-up. Dig Liver Dis. 2005 Oct;37(10):779-85. [PubMed]
14. Zimbwa TA, Blanshard C, Subramaniam A. Platelet count/spleen diameter ratio as a predictor of oesophageal varices in alcoholic cirrhosis. Gut. 2004 Jul;53(7):1055. [PubMed]
15. Andrew K Burroughs. The portal venous system and portal hypertension. Twelfth Edition. Wiley – Blackwell.2011.
16. D. Amico G, Luca A. Portal hypertension. Natural history. Clinical-hemodynamics correlation. Prediction of the risk of bleeding. Baillieres Clinical Gastroenterology 1 997;11:243-56.
17. Schepis F, Cammà C, Niceforo D, Magnano A, Pallio S, Cinquegrani M, D'amico G, Pasta L, Craxì A, Saitta A, Raimondo G. Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection? Hepatology. 2001 Feb;33(2):333-8.
18. Jijo V Cherian, Nandan Deepak, Rajesh Prabhu Ponnusamy, Aravindh Somasundaram, V Jayanti. Non-invasive predictors of esophageal varices. The Saudi Journal Of Gastroenterology 2011;17(1):64-68. [PubMed]
19. 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. 2008 Oct;22(10):825-8. [PubMed]
20. Abu El Makarem MA, Shatat ME, Shaker Y, Abdel Aleem AA, El Sherif AM, Moaty MA, Abdel Ghany HS, Elakad A, Kamal Eldeen AM. Platelet count/bipolar spleen diameter ratio for the prediction of esophageal varices: The special Egyptian situation: Noninvasive prediction of esophageal varices. Hepat Mon. Apr 1, 2011;11(4):278-84.
21. Tafarel JR, Tolentino LH, Correa LM, Bonilha DR, Piauilino P, Marlins FP, Rodrigues RA, Nakao FS, Libera ED, Ferrari AP, da Silveira Rohr MR. Prediction of esophageal varices in hepatic cirrhosis by noninvasive markers. Eur J Gastroenterol Hepatol. Sep 2011;23(9):754-8.
22. Mangone M, Moretti A, Alivemini F, Papi C, Oretlce R, Dezi A, Amadei E, Aratai A, Bianchi M, Tornatore V, Koch M. Platelet count/spleen diameter ratio for non-invasive diagnosis of oesophageal varices: Is it useful in compensated cirrhosis? Dig Liver Dis.2012; 44(6):504-507.
23. de Franchis R. Noninvasive diagnosis of esophageal varices: is it feasible? Am J Gastroenterol. 2006 Nov;101(11):2520-2. [PubMed]
24. Peck-Radosavljevic M. Thrombocytopenia in liver disease. Can J Gastroenterol. 2000 Nov;14 Suppl D:60D-66D. [PubMed]
25. 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 Jan-Mar;16(1):38-42. doi: 10.4103/1319-3767.58767.
26. Chawla S, Katz A, Attar BM, Gupta A, Sandhu DS, Agarwal R. Platelet count/spleen diameter ratio to predict the presence of esophageal varices in patients with cirrhosis: a systematic review. Eur J Gastroenterol Hepatol. Apr 2012;24(4):431-6.
CITATION
DOI: 10.17511/ijmrr.2016.i04.11
Published: 2016-04-30
How to Cite
1.
Nayak OP, Sukhwani N. A study of platelet count/ spleen diameter ratio as a predictor of esophageal varices in patients of cirrhosis. Int J Med Res Rev [Internet]. 2016Apr.30 [cited 2024Dec.23];4(4):537-42. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/514
Issue
Section
Original Article
OAI - Open Archives Initiative
