Non Invasive Predictor of Oesophgeal Varices in Cirrhosis- Platelet Count/Spleen Diameter Ratio

BACKGROUND : Current guidelines recommend that all cirrhotic patients must undergo screening endoscopy for the presence of oesophageal varices. With increasing number of patients with chronic liver disease and their improved survival, these guidelines impose a burden on the endoscopic units, available facilities and also economically. In this study we aim to identify the value of Platelet count/Spleen diameter ratio as a non invasive predictor of oesophageal varices in patients with cirrhosis and its predictive efficacy. MATERIALS AND METHODS : 60 patients with newly diagnosed cirrhosis admitted during a one year study period were evaluated prospectively. Patients with unstable vitals at admission, bleeders and history of prior treatment (Medical or Surgical) were excluded. All patients underwent biochemical work up, UGI scopy and ultrasonographic measurement for spleen diameter. Platelet count/spleen diameter ratio was calculated for all patients. RESULTS : Platelet count/spleen diameter ratio was found to be significantly different in patients with oesophageal varices and in those without. At a cutoff of 909, it had a sensitivity of 95.2% and specificity of 88.8%. Prevalence adjusted positive predictive value of the test was found to be 95% and negative predictive value of 89%. It also correlated significantly with other non invasive parameters such as ascites, platelet count, splenomegaly and Child-Pugh score. CONCLUSION : Platelet count/spleen diameter is valuable tool in non invasive prediction of oesophageal varices in patients with cirrhosis. Its use would avoid unnecessary endoscopy without a significant risk of missing oesophageal varices