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We read with great interest the article by Giannini et al (Gut 2003;52:1200–5) regarding platelet count/spleen diameter ratio as a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis.1 In patients with liver disease due to alcohol, platelet count is reduced due to the myelotoxic effect of alcohol. In the study, only 16.55% (24/145) of patients had liver cirrhosis due to alcohol. In the UK, alcohol is the commonest cause of liver cirrhosis.
We retrospectively studied endoscopy, haematology, and radiology reports of 40 patients who had been treated for alcohol induced cirrhosis at Homerton Hospital, London. Of these, 30 had oesophageal varices at endoscopy and 10 did not. The platelet count/spleen diameter ratio was calculated within two months of endoscopy.
The median platelet count/spleen diameter ratio in patients with varices was 537 (range 371–670) and with no varices 2229 (range 1542–3174). A platelet count/spleen diameter ratio of <909 had 100% sensitivity and specificity for the prediction of oesophageal varices in patients.
We have shown that this non-invasive method of predicting the presence of oesophageal varices through platelet count/spleen diameter ratio is reproducible in alcoholic cirrhotic patients.
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