Sensitivity and Specificity of Platelet Count/Splenic Diameter Ratio for Prediction of Oesophageal Varices in Indian Cirrhotics

Introduction: Development of esophageal varices and subsequent bleed in cirrhotics is the leading cause of mortality. The use of non-invasive methods to predict the presence of esophageal varices would help restrict endoscopic studies to those with a high probability of having varices. Various non-invasive tests have been tried as alternate methods to predict the presence of esophageal varices. Material and method: We studied 180 cirrhotic patients at Mahatma Gandhi medical college, Jaipur. Diagnosed cases of cirrhosis without any past history of upper GI bleed were included in study. Patient with history of fever, intake of antiplatelet drug, splenectomy and ongoing variceal bleed were excluded from study. We aimed to evaluate weather a ratio of platelet count to spleen diameter <909 could be used in Indian population to predict the presence of varices. Result: 85.6% patients of liver cirrhosis had low platelet count, while only 14.4% patients had platelets in normal range. Platelets count in predicting the severity of oesophageal varices was statistically significant(p<0.0001). 52.8% patients had splenic diameter >125mm. Significant correlation was found between the splenic diameter and severity of varices(p<0.0001). In this study maximum 66.11% patients had PC/SD ratio below 909 while remaining 33.9% patients had PC/SD ratio above 909. On comparing PC/SD ratio with severity of varices, there was significant correlation(p<0.0001). Conclusion: Platelet count/spleen diameter is a good predictor of oesophageal varices. The use of the platelet count/spleen diameter ratio also safely identified patients without oesophageal varices.