Are non invasive predictors of esophageal varices reliable?

Background: Bleeding from esophageal varices is a life-threatening complication in cirrhosis. Screening endoscopy is recommended in cirrhotic patients to identify patients at risk of variceal hemorrhage, but this is an invasive procedure and has limitations. Therefore, thrombocytopenia has been proposed to predict the existence and grade of esophageal varices. The aim of the current study was to determine a correlation between platelet count and grades of esophageal varices in patients with liver cirrhosis. Methods: This cross-sectional study was conducted at the POF Hospital, Wah Cantt from 1st October, 2017 to 30th May, 2018. Newly diagnosed cases of cirrhosis having varices of any grade on endoscopy were included. Endoscopic findings of patients were standardized using Paquet grading system. On the basis of platelet count, patients were divided into four subgroups. Platelet count groups were correlated with grading of esophageal varices using Spearman rank correlations. Chi Square test was used to see association between the platelet count and grade of esophageal varices. Results: 110 patients were included in the study, 55.5% (n=61) were male. Mean age of the patients was 59.89±9.01 years. Platelet count was <50,000/uL in 35.5% patients, 50,000-99,000/uL in 26.4%, 100,000-150000 in 12.7%, and >150,000/uL in 25.5% patients. Grade I esophageal varices were found in 23.6% of patients, whereas grade II, III and IV were found in 24.5%, 33.6% and 18.2% of patients, respectively. Mean platelet count was 213884.62/mm3 in patients with grade I varices, whereas it was 119518.52/mm3, 58386.49/mm3 and 21600.00/mm3 in patients with grade II, III and IV varices, respectively (p=<0.0001). A significant negative correlation between platelet count and grades of esophageal varices was found (p<0.001). Conclusion: Platelet count can predict the grade of esophageal varices in cirrhotic patients. There is significant negative correlation between platelet count and grades of esophageal varices.

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Platelet Count/Spleen Diameter Ratio as a Predictor of Esophageal Varices in Patients with Liver Cirrhosis

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v15i2.22842 ◽

2017 ◽

Vol 15 (2) ◽

pp. 37-40

Author(s):

Dipendra Khadka ◽

Sudhamshu KC ◽

Sandip Khadka ◽

Kiran Regmi ◽

Pooja KC

Keyword(s):

Liver Cirrhosis ◽

Platelet Count ◽

Esophageal Varices ◽

Complete Blood Count ◽

Liver Function Tests ◽

Cross Sectional Study ◽

Diameter Ratio ◽

Cross Sectional ◽

Predictive Values ◽

Non Invasive

Introduction: Upper gastro-intestinal endoscopy still remains the gold standard for screening of patients suspected to have esophageal varices but not without limitations. So, this study was conducted to access the diagnostic validity and correlation between non-invasive parameters like platelet count, spleen diameter and their ratio with esophageal varices (EV) in patients with liver cirrhosis. Methods: A hospital based descriptive cross-sectional study was carried out in Liver unit of National Academy of Medical Sciences, Bir Hospital, from October 2016 to September 2017. Complete blood count, liver function tests, liver ultrasound and UGI endoscopy were done for all patients included in the study to detect esophageal varices and the platelet count/spleen diameter (PC/SD) ratio was calculated and analyzed to determine whether it can predict the presence of esophageal varices or not. Results: Total patients of liver cirrhosis studied after exclusion were 191 EV was present in 125 patients (65.4%). The platelet count/spleen diameter ratio using a cutoff value of ≤ 909 to detect EV independent of the grade had 93% sensitivity and 100% specificity and positive and negative predictive values of 100% and 91% respectively. Conclusions: PC/SD ratio now can be used as a predictor of presence of esophageal varices in liver cirrhosis.

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Platelet count can predict the grade of esophageal varices in cirrhotic patients: a cross-sectional study

F1000Research ◽

10.12688/f1000research.28005.1 ◽

2021 ◽

Vol 10 ◽

pp. 101

Author(s):

Anum Afsar ◽

Muhammad Nadeem ◽

Syed Asim Ali Shah ◽

Huma Hussain ◽

Aysha Rani ◽

...

Keyword(s):

Platelet Count ◽

Negative Correlation ◽

Esophageal Varices ◽

Significant Negative Correlation ◽

Cross Sectional Study ◽

Variceal Hemorrhage ◽

Sectional Study ◽

Cross Sectional ◽

Grade Ii ◽

Cirrhotic Patients

Background: Bleeding from esophageal varices is a life-threatening complication in cirrhosis. Screening endoscopy is recommended in cirrhotic patients to identify patients at risk of variceal hemorrhage, but this is an invasive procedure and has limitations. Therefore, thrombocytopenia has been proposed to predict the existence and grade of esophageal varices. The aim of the current study was to determine a correlation between platelet count and grades of esophageal varices in patients with liver cirrhosis. Methods: This cross-sectional study was conducted at the POF Hospital, Wah Cantt from 1st October, 2017 to 30th May, 2018. Newly diagnosed cases of cirrhosis having varices of any grade on endoscopy were included. Endoscopic findings of patients were standardized using Paquet grading system. On the basis of platelet count, patients were divided into four subgroups. Platelet count groups were correlated with grading of esophageal varices using Spearman rank correlations. Chi Square test was used to see association between the platelet count and grade of esophageal varices. Results: 110 patients were included in the study, 55.5% (n=61) were male. Mean age of the patients was 59.89±9.01 years. Platelet count was <50,000/uL in 35.5% patients, 50,000-99,000/uL in 26.4%, 100,000-150000 in 12.7%, and >150,000/uL in 25.5% patients. Grade I esophageal varices were found in 23.6% of patients, whereas grade II, III and IV were found in 24.5%, 33.6% and 18.2% of patients, respectively. Mean platelet count was 213884.62/mm3 in patients with grade I varices, whereas it was 119518.52/mm3, 58386.49/mm3 and 21600.00/mm3 in patients with grade II, III and IV varices, respectively (p=<0.0001). A significant negative correlation between platelet count and grades of esophageal varices was found (p<0.001). Conclusion: Platelet count can predict the grade of esophageal varices in cirrhotic patients. There is significant negative correlation between platelet count and grades of esophageal varices.

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A Cross Sectional Study of Correlation of Portal Vein Diameter with the Physical Data in Bangalore Karnataka

Indian Journal of Public Health Research & Development ◽

10.5958/j.0976-5506.5.1.043 ◽

2014 ◽

Vol 5 (1) ◽

pp. 190

Author(s):

G Ravi Shankar ◽

Shailaja Shetty

Keyword(s):

Portal Vein ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Physical Data ◽

Vein Diameter

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PLATELET COUNT SQUARED/SPLEEN DIAMETER-ASPARTATE AMINOTRANSFERASE RATIO: NON-INVASIVE METHOD TO PREDICT ESOPHAGEAL VARICES

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.201700000-26 ◽

2017 ◽

Vol 54 (3) ◽

pp. 222-224 ◽

Cited By ~ 1

Author(s):

Ângelo Zambam de MATTOS ◽

Larissa Faraco DAROS ◽

Angelo Alves de MATTOS

Keyword(s):

Logistic Regression ◽

Platelet Count ◽

Esophageal Varices ◽

Predictive Value ◽

Aspartate Aminotransferase ◽

Univariate Analysis ◽

Cross Sectional Study ◽

Cross Sectional ◽

Predictive Values ◽

Non Invasive

ABSTRACT BACKGROUND - Variceal bleeding has a high mortality among cirrhotics, and screening with endoscopy is indicated at the diagnosis of cirrhosis. Screening with endoscopy implies discomfort, risks and considerable costs. OBJECTIVE - To evaluate platelet count squared/spleen diameter-aspartate aminotransferase ratio (PS/SA), as a non-invasive predictor of esophageal varices in cirrhotics. METHODS - This cross-sectional study evaluated cirrhotics for PS/SA and presence of esophageal varices. Outpatient records of cirrhotic patients were reviewed for the abovementioned data. Sensitivity, specificity, negative and positive predictive values of PS/SA were calculated. After the univariate analysis, variables with P<0.10 were submitted to a logistic regression. RESULTS - The study included 164 cirrhotics, 59.70% male, with a mean age of 56.7 years. Hepatitis C was the most frequent cause of cirrhosis, being present in 90 patients. Patients were classified as Child-Pugh A in 52.44% and as Child-Pugh B or C in 47.56%. Esophageal varices were present in 72.56% of the patients at endoscopy. PS/SA, with a cutoff of 3x108, had a sensitivity of 95.80% (confidence interval of 95% - 95%CI=0.92-0.99), a specificity of 22.70% (95%CI=0.10-0.35), a positive predictive value of 77.20% (95%CI=0.70-0.84) and a negative predictive value of 66.70% (95%CI=0.42-0.91). In the logistic regression, only platelet count and Child-Pugh score were associated to esophageal varices (P<0.05). CONCLUSION - PS/SA has an excellent sensitivity to predict esophageal varices, allowing almost one fourth of patients without esophageal varices to spare endoscopy. Nevertheless, PS/SA is not independently associated to esophageal varices.

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ESOPHAGEAL VARICES;

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.05.1201 ◽

2013 ◽

Vol 20 (05) ◽

pp. 653-660

Author(s):

AHSAN AYUB

Keyword(s):

Platelet Count ◽

Portal Vein ◽

Esophageal Varices ◽

Clinical Laboratory ◽

Oesophageal Varices ◽

Upper Gastrointestinal Endoscopy ◽

High Morbidity ◽

Cross Sectional ◽

Need To Evaluate ◽

Vein Diameter

Bleeding from esophageal varices is associated with high morbidity and mortality. It is currently recommended that allpatients with liver cirrhosis undergo upper gastrointestinal endoscopy to identify those who have esophageal varices. This approachleads to unnecessary endoscopies. There is need to evaluate clinical, laboratory and imaging parameters that may predict the presence ofesophageal varices and help select patients for endoscopy. Objective: Identify hematological, biochemical and ultasonographicpredictors of oesophageal varices in patients of cirrhosis. Study design: Cross sectional Descriptive study. Setting: Department ofGeneral Medicine and Gastroenterology unit 1, Services Hospital, Lahore. Duration of study: 6 months (April 01, 2007 – September 30,2007). Sample size: Study was done on One hundred patients who had established cirrhosis with oesophageal varices. Results: Majority(77%) were male who had evidence of esophageal varices. Hematemesis was the presenting complaint in 75% of patients and majority(83%) had clinically palpable spleen. Esophageal varices were present in 75% of patents who had platelet count <100, 000. In patientswho had portal vein diameter of >20mm 41% had evidence of esophageal varices. Splenic measurement of >13cm was associated withmaximum number of cases of esophageal varices i.e 82%. Conclusion: It is concluded from the study that male gender, clinically palpablespleen, low platelet count, portal vein diameter and splenic measurement can be used as non invasive parameters to predict esophagealvarices reducing the need of unnecessary endoscopies.

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Computed Tomography Angiography (CTA) Evaluation of Spontaneous Subarachnoid Hemorrhage

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v6i2.50745 ◽

2020 ◽

Vol 6 (2) ◽

pp. 78-81

Author(s):

Md Tauhidul Islam Chowdhury ◽

Mohammad Shah Jahirul Hoque Chowdhury ◽

Mohammad Sadekur Rahman Sarkar ◽

KM Ahasan Ahmed ◽

Md Nazmul Kabir ◽

...

Keyword(s):

Computed Tomography ◽

Subarachnoid Hemorrhage ◽

Computed Tomography Angiography ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Multiple Aneurysm ◽

Traumatic Subarachnoid Hemorrhage ◽

One Year ◽

Spontaneous Subarachnoid Hemorrhage

Background: In evaluation of non-traumatic subarachnoid hemorrhage CT angiography (CTA) has 97-98% sensitivity and near 100% specificity. Objective: This study was conducted to evaluate the CTA findings of CT positive non traumatic subarachnoid hemorrhage. Methodology: This is an observational cross sectional study performed in Neurology department of National Institute of Neurosciences and Hospital, Dhaka over one year period (January 2019 to December 2019). Total 87 CT positive subarachnoid hemorrhage cases were purposively included in this study. All CT positive patients underwent CTA of Cerebral vessels for further evaluation. The angiography were evaluated by competent neuro-radiologists blinded about the study. Result: Among 87 patients, 40.2% were male and 59.8% were female. The average age was 53.33±11.1 years. Among the studied patient the source of bleeding was found 78.16% aneurysmal and 21.84% non-aneurysmal. 85.30% patients had single aneurysm and 14.70% had multiple aneurysm. The highest number of patient had Acom aneurysm (41.17%) followed by MCA (22.05%), ICA (13.23%), ACA (7.35%) and vertebral artery (1.14%) in order of frequency. Among the multiple aneurysm group most of the patients had combination of Acom, MCA and ICA aneurysm. Conclusion: From this study, we can conclude that CTA can be used as the primary diagnostic tool in evaluation of spontaneous SAH. Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 78-81

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