PLATELET COUNT AND SPLEEN DIAMETER RATIO FOR NON INVASIVE DIAGNOSIS OF ESOPHAGEAL VARICES

2021 ◽  
pp. 14-18
Author(s):  
Pooja Krishnappa ◽  
Vasant PK ◽  
Subhash Chandra
Keyword(s):  
Platelet Count ◽  
Roc Curve ◽  
Esophageal Varices ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Meld Score ◽  
Diameter Ratio ◽  
P Value ◽  
Cutoff Value ◽  
Non Invasive

BACKGROUND: Portal Hypertension and its consequences mainly, Esophageal Varies (EVs) is one of the most important causes of morbidity and mortality in patients with cirrhosis of liver. Upper GI endoscopy is the investigation of choice for diagnosis of EVs and periodic endoscopies have been recommended for monitoring of varices. There is a need for non-invasive parameters to detect the presence of EVs. Identication of noninvasive predictors of EVs will help us to carry out EGD in selected groups of patients. Unnecessary endoscopies can be avoided and at the same time, patients who require endoscopy can be referred to a higher center, where facilities for endoscopy are available. Among the non-invasive modalities, the platelet count and bipolar spleen diameter ratio has shown promising results in terms of its accuracy in predicting the presence of Esophageal Varices in many studies MATERIALS AND METHODS: Patients with chronic liver disease diagnosed using clinical, Laboratory and ultrasound parameters were assessed using esophagogastroduodenoscopy for the presence or absence of esophageal varices. USG abdomen was done to assess for bipolar splenic diameter and the presence or absence of EV's was correlated with the platelet count/ splenic diameter ratio, CHILD SCORE, MELD score, Platelet count alone and splenic diameter alone. Platelet count/SD ratio of 909 based on previous studies was correlated with the presence or absence of varices. Statistical analysis was done using IBM SPSS software version 20.0 and variables showing statistically signicant correlations with presence of arices were used for plotting ROC curves to assess the cut of points which could be used for non invasive prediction of varices. RESULTS: The PC/SD ratio cut off (909), based on previous studies for non invasive diagnosis of Esophageal Varices gave sensitivity and specicity of 97.9% and 91.7% respectively, in our study, which was statistically signicant (P value <0.001). The positive predicitive value and negative predictive value of the PC/SD ratio (909) was 96.5% and 94.8% respectively and the accuracy of the test was 96%. ROC curve for Platelet count and Splenic diameter ratio area under the curve is 97.8% with P value < 0.001 and cutoff value 895.02 with sensitivity 96.6% and specicity 96.5%. The Positive predictive value and negative predictive value of PC/SD ratio of 895 was found to be 98.6% and 91.8% respectively and the accuracy of the test 96.5%. ROC curve for Child score in our study, area under the curve 71% with a signicant P value < 0.001, and cut-off value obtained for Child score was 8.50 with sensitivity 64.8% and specicity 63.8 %. ROC curve for MELD score revealed area under the curve was 74.3% with P value as < 0.001, and the cut-off value was 15.5 with sensitivity 67.6 % and specicity 67.2%. ROC curve for Platelet count in our study, the area under the curve was 94.5% with P value as < 0.001, and the cut-off value was 108500 with sensitivity and specicity of 89.7% and 89.4% respectively. The ROC curve for Spleen diameter in our study revealed that the area under the curve was 86.8%% with P value as < 0.001, and the cutoff value was 121 with sensitivity and specicity of 78.9% and 81.0% respectively. CONCLUSION: Among the variables studied for non-invasive diagnosis of Esophageal varices, the Platelet count / Spleen diameter ratio had the best sensitivity and specicity for diagnosing EVs. In view of low sensitivities and specicities for the cut off values obtained for Child score, MELD score, platelet count and spleen diameter, these indices may not be useful as PC/SD ratio in the non-invasive prediction of EV's. The Platelet count / Splenic diameter ratio may be proposed as a safe parameter for diagnosing Esophageal Varices in Chronic Liver disease noninvasively, where resources are limited and endoscopy facilities are not available, to select the patients with probable Esophageal Varices who can be referred to higher centres

scholarly journals Platelet count splenic diameter ratio as predictor for esophageal varices in patients with cirrhosis: a diagnostic evaluation study

2019 ◽  
Vol 7 (12) ◽  
pp. 4535
Author(s):  
Sunil Mathew ◽  
Sachin Chacko ◽  
Tomy Philip ◽  
R. N. Sharma ◽  
Kanniyan Binub
Keyword(s):  
Platelet Count ◽  
Positive Predictive Value ◽  
Esophageal Varices ◽  
Predictive Value ◽  
Evaluation Study ◽  
Diameter Ratio ◽  
Diagnostic Evaluation ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding ◽  
Non Invasive

Background: Esophageal variceal bleeding is one among the common complication of cirrhosis which is fatal. Latest studies are focusing more on using non-invasive techniques to classify cirrhotic patients according to their risk of having varices. The platelet count-splenic diameter ratio is considered as one such parameter and is used in predicting esophageal varices in patients with cirrhosis. Objectives of the study was to assess the utility of platelet count-splenic diameter ratio as a useful non- invasive parameter in predicting the presence/ absence /size of esophageal varices in patients with cirrhosis.Methods: Diagnostic evaluation study was done in a tertiary hospital of Kerala state India. 93 adults above the age of 18 yrs with diagnosis of cirrhosis was selected and detailed history, physical, systemic examination and imaging was done. The degree of correlation between platelet count-splenic size ratio and the presence/absence/size of esophageal varices was studied along with its utility as an independent non- invasive marker. Frequency was expressed in percentages.Results: Best cut-off for prediction of esophageal varices Grade 1 was platelet count/spleen diameter ratio of 954, which had Specificity of 85.7% and Positive predictive value of 94.1% Cut-off for prediction of Grade 2 esophageal varices was platelet count/spleen diameter ratio of 916 which had a Sensitivity of 78.9%, Specificity of 88.9%. Whereas cut-off for prediction of Grade 3 esophageal varices was a ratio of 899 which had a high Sensitivity of 88% and Negative predictive value of 93.6 % but Specificity was only 64.7% and Positive predictive value of 47.8% only.Conclusions: The platelet count splenic diameter ratio is accurate to be used as screening tool to predict the presence of Grade 2 Esophageal varices in Patients with Cirrhosis. More studies need to be done around the globe for more evidence.

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

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.

scholarly journals Platelet Count/Splenic Diameter Ratio to Predict Oesophageal Varices in Portal Hypertension

2019 ◽  
Vol 2 (2) ◽  
pp. 192-196
Author(s):  
Buddhi Sagar Lamichhane ◽  
Manoj Koirala ◽  
Bishwo Raj Baral
Keyword(s):  
Liver Cirrhosis ◽  
Platelet Count ◽  
Portal Hypertension ◽  
Esophageal Varices ◽  
Rural Areas ◽  
Predictive Value ◽  
Tertiary Hospital ◽  
Diameter Ratio ◽  
Oesophageal Varices ◽  
Cirrhosis Of Liver

Background: One of the major causes of morbidity and mortality in Nepal is portal hypertension due to liver cirrhosis. In rural areas where a lot of cases of cirrhosis of liver are prevalent and endoscopic expertise and facilities are not available, predicting the presence of esophageal varices through non-invasive means may reduce a large number of unnecessary endoscopies. This study is to identify the relationship of platelet count /splenic bipolar diameter ratio with the presence of esophageal varices in portal hypertension. Materials and methods: Eighty patients were included in this study between Jestha 2072 to Baisakh 2073 with the diagnosis of portal hypertension admitted in Bir hospital, Kathmandu which is a tertiary hospital of government of Nepal, which were mostly due to liver cirrhosis. The patients fulfilling the inclusion criteria underwent lab investigations, ultra sonogram and UGI endoscopy. The data were assessed for descriptive studies and means were compared using t-test. The cut off value of platelet count to spleen diameter ratio of 1150 was used to predict the presence or absence of oesophageal varices. Statistical analysis was done using SPSS 20 software Results: Platelet count to splenic diameter ratio with a cut off value of 1150 has sensitivity of 89.7%, specificity of 83.3%, positive predictive value of 96.8% and negative predictive value of 58.8% (p= 0.002, CI=95%) with 89.5 % accuracy. Conclusion: Platelet count to splenic bipolar diameter ratio can be a good predictor of presence of esophageal varices in patients with portal hypertension in the resource poor settings.

scholarly journals Non-Endoscopic Parameters for Predicton of Esophageal Varices

2017 ◽  
Vol 6 (2) ◽  
pp. 21-26
Author(s):  
Rahul Pathak ◽  
Roshan Jha ◽  
Prem Khadga ◽  
Shashi Sharma
Keyword(s):  
Platelet Count ◽  
Diagnostic Accuracy ◽  
Esophageal Varices ◽  
Rural Areas ◽  
Financial Burden ◽  
Tertiary Care ◽  
Diameter Ratio ◽  
Spleen Size ◽  
Non Invasive ◽  
Screening Endoscopy

Introduction: Non invasive assessment of esophageal varices may improve the management and lower the medical and financial burden related to the screening. In this study, Our aim was to validate the prediction of varices using platelet count/spleen diameter ratio and Alanine transaminase/platelet ratio index (APRI).Methods: Fifty patients with newly diagnosed and treatment naive cirrhosis underwent screening endoscopy along with hematological and ultrsonographic studies. Platelet count/spleen diameter ratio and APRI index were assessed and their diagnostic accuracy calculated. Based on previous studies, a cutoff of 909 was applied for platelet count/spleen diameter ratio and cutoff of > 1.3 for APRI. The diagnostic accuracy of both the indices were further evaluated for severity and size of varices.Results: Prevalence of varices was 36% out of which 24% were large varices. Platelet count/spleen size diameter, portal vein diameter and APRI index had significant association for prediction of presence of varices and strongly correlated with size of varices. Platelet count/spleen size diameter of 909 had diagnostic accuracy of 80.5% for prediction of varices with diagnostic accuracy being 95.8 for predicting large varices. APRI index of more than 1.3 had accuracy of 75% for predicting varices and 87.5% for accurately predicting them as large varices.Conclusions: In a resource limited country like ours, where access to specialized and tertiary care hospitals and availability of endoscopy facilities in rural areas is an issue, these non invasive parameters platelet count/spleen diameter and APRI can be taken as a safe and reliable predictor for esophageal varices.Journal of Advances in Internal Medicine 2017;06(02):21-26.

scholarly journals Platelet count/spleen diameter ratio for non-invasive prediction of high risk esophageal varices in cirrhotic patients

2009 ◽  
Vol 8 (4) ◽  
pp. 325-330 ◽  
Author(s):  
Francisco Barrera ◽  
Arnoldo Riquelme ◽  
Alejandro Soza ◽  
Álvaro Contreras ◽  
Gerty Barrios ◽  
...  
Keyword(s):  
Platelet Count ◽  
High Risk ◽  
Esophageal Varices ◽  
Diameter Ratio ◽  
Non Invasive ◽  
Cirrhotic Patients

scholarly journals Significance of Non-Invasive Markers as Predictor of Esophageal Varices in Liver Cirrhosis

2017 ◽  
Vol 56 (208) ◽  
pp. 412-6 ◽  
Author(s):  
Dipendra Khadka ◽  
Sushil Prajapati ◽  
Sudhamshu KC ◽  
Jeetendra Kaji Shrestha ◽  
Niyanta Karki ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Platelet Count ◽  
Esophageal Varices ◽  
Complete Blood Count ◽  
Clinical Expertise ◽  
Spleen Size ◽  
Cross Sectional ◽  
Cutoff Value ◽  
Non Invasive ◽  
Pugh Class

Introduction: Upper gastro-intestinal endoscopy remains the gold standard for screening for esophageal varices but it has its own limitations. It is an invasive, expensive and uncomfortable procedure and needs clinical expertise. Accordingly, this study was conducted to establish the role of non-invasive markers for prediction of esophageal varices in 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 test, liver ultrasound and upper gastro-intestinal endoscopy were done for all patients to detect esophageal varices and to correlate with different non-invasive markers. Results: Total 191 patients of liver cirrhosis were studied after exclusion. Platelet count of 92082.00±43435.83/mm3 and spleen size of 144.21±10.71 mm was found to be good predictors of presence of EV (P≤0.001). Significant association between Child-Turcotte-Pugh class and presence of varices was observed (P≤0.001). AST/ALT ratio with cutoff value of 1.415 showed sensitivity of 82.4% and specificity of 36.4%. APRI at a cutoff value of 1.3 showed a sensitivity of 83.2% and specificity of 50%. Conclusions: Platelet count, spleen size and Child-Turcotte-Pugh class are good predictors of presence of esophageal varices in patients with liver cirrhosis. AST/ALT ratio and APRI score are not good substitutes for upper gastro-intestinal endoscopy.   Keywords:  esophageal varices; liver cirrhosis; non-invasive markers; portal hypertension; upper gastro-intestinal.

scholarly journals Prediction of esophageal varices and variceal hemorrhage in patients with acute upper gastrointestinal bleeding

2016 ◽  
Vol 64 (3) ◽  
pp. 745-751 ◽  
Author(s):  
Don C Rockey ◽  
Alan Elliott ◽  
Thomas Lyles
Keyword(s):  
Logistic Regression ◽  
Platelet Count ◽  
Gastrointestinal Bleeding ◽  
Esophageal Varices ◽  
Upper Gastrointestinal Bleeding ◽  
Area Under The Curve ◽  
Variceal Hemorrhage ◽  
Esophageal Variceal ◽  
Non Invasive ◽  
Upper Gastrointestinal

In patients with upper gastrointestinal bleeding (UGIB), identifying those with esophageal variceal hemorrhage prior to endoscopy would be clinically useful. This retrospective study of a large cohort of patients with UGIB used logistic regression analyses to evaluate the platelet count, aspartate aminotransferase (AST) to platelet ratio index (APRI), AST to alanine aminotransferase (ALT) ratio (AAR) and Lok index (all non-invasive blood markers) as predictors of variceal bleeding in (1) all patients with UGIB and (2) patients with cirrhosis and UGIB. 2233 patients admitted for UGIB were identified; 1034 patients had cirrhosis (46%) and of these, 555 patients (54%) had acute UGIB due to esophageal varices. In all patients with UGIB, the platelet count (cut-off 122,000/mm3), APRI (cut-off 5.1), AAR (cut-off 2.8) and Lok index (cut-off 0.9) had area under the curve (AUC)s of 0.80 0.82, 0.64, and 0.80, respectively, for predicting the presence of varices prior to endoscopy. To predict varices as the culprit of bleeding, the platelet count (cut-off 69,000), APRI (cut-off 2.6), AAR (cut-off 2.5) and Lok Index (0.90) had AUCs of 0.76, 0.77, 0.57 and 0.73, respectively. Finally, in patients with cirrhosis and UGIB, logistic regression was unable to identify optimal cut-off values useful for predicting varices as the culprit bleeding lesion for any of the non-invasive markers studied. For all patients with UGIB, non-invasive markers appear to differentiate patients with varices from those without varices and to identify those with a variceal culprit lesion. However, these markers could not distinguish between a variceal culprit and other lesions in patients with cirrhosis.

scholarly journals Significance of platelet indices as severity marker in nonthrombocytopenic preeclampsia cases

2019 ◽  
Vol 11 (03) ◽  
pp. 186-191
Author(s):  
Shilpa Gopal Reddy ◽  
Chinaiah Subramanyam Babu Rajendra Prasad
Keyword(s):  
Disease Progression ◽  
Roc Curve ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Severe Preeclampsia ◽  
Roc Curve Analysis ◽  
Diagnostic Significance ◽  
Distribution Width ◽  
Cutoff Value ◽  
Binary Regression Analysis

Abstract CONTEXT: Preeclampsia is often asymptomatic, and hence, its detection depends on signs or investigations. The platelet (PLT) parameters, in cases of preeclampsia with normal PLT count, are seldom analyzed. Hence, this study was undertaken to study the PLT parameters in nonthrombocytopenic preeclampsia cases. AIM: The aim was to evaluate the use of PLT indices as severity markers in nonthrombocytopenic preeclampsia cases. SUBJECTS AND METHODS: This prospective study was done on 120 cases of severe preeclampsia, 115 cases of preeclampsia without severe features, and 203 normal pregnant women admitted in the obstetrics wards during the study period of 1 year. The PLT indices obtained by analyzing anticoagulated blood were recorded. STATISTICAL ANALYSIS USED: Analysis of variance test was used to see the significance of association. Receiver operating characteristic (ROC) curve and binary regression analysis was used to estimate the cutoff value and examine the predictive value of the PLT parameters in the disease progression of preeclampsia. RESULTS: Even in the absence of thrombocytopenia, mean platelet volume (MPV) and PLT distribution width were significantly higher in severe preeclampsia group (P < 0.001) and were also positively correlating with mean arterial pressure (r = 0.38 and 0.20, respectively). ROC curve analysis showed that MPV had the highest area under the curve of 0.78 (95% confidence interval [0.719‒0.842]). Cutoff value of >10.95 fl for MPV was found to have significant predictive value for disease progression in preeclampsia. CONCLUSIONS: Even in the absence of thrombocytopenia, PLT indices, especially MPV, have a good diagnostic significance in detecting severe preeclampsia. Further studies are required to evaluate their role as biomarkers in preeclampsia.

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