LIVER

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

E Giannini¹, F Botta¹, P Borro¹, D Risso², P Romagnoli¹, A Fasoli¹, M R Mele¹, E Testa¹, C Mansi¹, V Savarino¹, R Testa¹

¹ Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Italy
² Medical Statistics Section, Department of Health Sciences, University of Genoa, Italy

Correspondence to:
Correspondence to:
Professor R Testa, Gastroenterology Unit, Department of Internal Medicine (DIMI), Viale Benedetto XV No 6, 16132 Genova, Italia;
rtesta{at}unige.it

Background and aims: Cirrhotic patients frequently undergo screening endoscopy for the presence of oesophageal varices (OV). In the future, this social and medical burden will increase due to the greater number of patients with chronic liver disease and their improved survival. In this study, our aims were (1) to identify clinical, biochemical, and ultrasonographic parameters which might non-invasively predict the presence of OV in patients with liver cirrhosis; (2) to evaluate the reproducibility of the obtained results in a different, although related, further group of patients; and (3) to assess the predictiveness of the identified rules in patients with compensated cirrhosis.

Methods: In the first part of the study we retrospectively evaluated the presence of OV in 145 cirrhotic patients, and in the second part we evaluated the reproducibility of the study results in a subsequent group of 121 patients. Finally, we evaluated these parameters in a subgroup of 145 patients with compensated disease. All 266 patients underwent a complete biochemical workup, upper digestive endoscopy, and ultrasonographic measurement of spleen bipolar diameter. Platelet count/spleen diameter ratio was calculated for all patients.

Results: The prevalence rates of OV were 61% and 58% in the first and second groups of patients, respectively. In the first part of the study, we found that platelet count, spleen diameter, platelet count/spleen diameter ratio, and Child- Pugh class were significantly different among patients with or without OV, although the platelet count/spleen diameter ratio was the only parameter which was independently associated with the presence of OV in a multivariate analysis. A platelet count/spleen diameter ratio cut off value of 909 had 100% negative predictive value for a diagnosis of OV. This result was reproduced in the second group of patients as well as in patients with compensated disease. In a cost-benefit analysis, screening cirrhotic patients according to the "platelet count/spleen diameter ratio strategy" was far more cost effective compared with the "scope all strategy".

Conclusions: The platelet count/spleen diameter ratio is the only parameter which is independently associated with the presence of OV, and its negative predictive value is reproducible. Its use is of value even in the subgroup of patients with compensated disease, and it is also cost effective.

Keywords: oesophageal varices; liver cirrhosis; platelet count; spleen diameter; endoscopy

Abbreviations: OV, oesophageal varices; NOV, no oesophageal varices; ROC curves, receiver operating characteristic curves

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Articles

Right liver lobe diameter:albumin ratio: a new non-invasive parameter for prediction of oesophageal varices in patients with liver cirrhosis (preliminary report) • Author’s reply

Tamara Alempijevic, Nada Kovacevic, and R Testa
Gut 2007 56: 1166-1167. [Extract] [Full Text] [PDF]

Digest

Robin Spiller
Gut 2003 52: 1075. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Liu, C.-H., Hsu, S.-J., Liang, C.-C., Tsai, F.-C., Lin, J.-W., Liu, C.-J., Yang, P.-M., Lai, M.-Y., Chen, P.-J., Chen, J.-H., Kao, J.-H., Chen, D.-S. (2008). Esophageal Varices: Noninvasive Diagnosis with Duplex Doppler US in Patients with Compensated Cirrhosis. Radiology 248: 132-139 [Abstract] [Full Text]  
• Farber, E., Fischer, D., Eliakim, R., Beck-Razi, N., Engel, A., Veitsman, E., Chermesh, I., Yassin, K., Gaitini, D., Libes, M., Linn, S., Soboh, S., Baruch, Y. (2005). Esophageal Varices: Evaluation with Esophagography with Barium versus Endoscopic Gastroduodenoscopy in Patients with Compensated Cirrhosis--Blinded Prospective Study. Radiology 237: 535-540 [Abstract] [Full Text]  
• (2004). Additional articles abstracted in ACP Journal Club. Evid. Based Med. 9: 35-35 [Full Text]  

eLetters:

Read all eLetters

Prediction of oesophageal varices with platelet count/spleen diameter ratio or platelets alone ?

Dominique Thabut, et al.

Gut Online, 24 Nov 2003 [Full text]

Platelet count with or without spleen diameter? The case when accompanied is better than alone.

Edoardo G. Giannini, et al.

Gut Online, 11 Dec 2003 [Full text]

Platelet count/Spleen diameter ratio as a predictor of oesophageal varices in alcoholic cirrhosis.

Truman Austin Zimbwa, et al.

Gut Online, 15 Mar 2004 [Full text]

Infallibility of a normal platelet count/spleen diameter ratio in ruling out oesophageal varices?

Daniel J Brotman, et al.

Gut Online, 7 Apr 2004 [Full text]