Use of the platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices in patients with schistosomiasis

Agha, Adnan; Abdulhadi, Mamdouh M; Marenco, S.; Bella, Abdelhaleem; Alsaudi, Dib; Elhaddad, A.; Inferrera, Simona; Savarino, Vincenzo; Giannini, Edoardo G.

doi:10.4103/1319-3767.84483

Cited by 19 publications

(7 citation statements)

References 33 publications

(31 reference statements)

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“…Agha et al [ 23 ] found that median platelet count (82,000 vs 172,000/μL; P < 0.0001) in cirrhotic patients correlated with the presence or absence of EV, respectively.…”

Section: Discussionmentioning

confidence: 99%

Correlation of platelets count with endoscopic findings in a cohort of Egyptian patients with liver cirrhosis

et al. 2016

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Screening endoscopy is recommended for early detection of esophageal varices (EVs) in cirrhotic patients with portal hypertension. However, this approach is limited by its invasiveness and cost. The aim of the study was to determine if platelet count can predict the presence of EVs, especially large (grade III, IV) EVs in need of prophylactic therapy, in a cohort of Egyptian patients with liver cirrhosis. In all, 110 patients with cirrhosis were prospectively analyzed. The presence of medium or large EVs was correlated with patients’ platelet count and FIB-4. Esophageal varices were present in 87 (79.09%) patients. Among those with thrombocytopenia (platelet level below 150,000), 25.97% (20 patients) and 27.27% (21 patients) had EV grade II and EV grade III or IV, respectively. Whereas in patients in whom the platelet count was above 150,000, only 21.21% (7 patients) and 9.09% (3 patients) of patients had grade II EV and EV grade III or IV, respectively. A platelet count cut-off value of 149,000 was found to have specificity of 82% and sensitivity 39% for detection of presence of varices. A FIB-4 cut-off value of 3.175 was found to have an 83.3% sensitivity and 39.5% specificity in detecting large (grade III, IV) EVs. Platelet count is a noninvasive parameter with high accuracy for prediction of EVs. Cirrhotic patients with normal platelet counts (above 150,000), especially in financially deprived developing countries, can avoid screening endoscopy as they are at a low risk for variceal bleeding, and presence of large EVs in these patients is much less common than in those with thrombocytopenia. A 3.175 cut-off value of FIB-4 could be useful as a noninvasive predictor of large varices requiring prophylactic banding in cirrhotic patients.

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“…Agha et al [ 23 ] found that median platelet count (82,000 vs 172,000/μL; P < 0.0001) in cirrhotic patients correlated with the presence or absence of EV, respectively.…”

Section: Discussionmentioning

confidence: 99%

Correlation of platelets count with endoscopic findings in a cohort of Egyptian patients with liver cirrhosis

et al. 2016

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“…2 papers [ 10 , 20 ] were published in abstracts and 47 papers were full-texts. The etiologies of cirrhosis were alcohol, schistosomiasis, and viral hepatitis in 1 [ 12 ], 2 [ 5 , 32 ], and 13 [ 9 , 19 , 22 , 26 , 27 , 30 , 33 , 36 , 39 , 40 , 42 – 44 ] papers, respectively. Two papers were about EV and GV [ 8 , 12 ], and the rest of the papers were about EV alone.…”

Section: Resultsmentioning

confidence: 99%

Platelet Count to Spleen Diameter Ratio for the Diagnosis of Gastroesophageal Varices in Liver Cirrhosis: A Systematic Review and Meta-Analysis

Chen

Deng

Ding

et al. 2017

Gastroenterology Research and Practice

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Platelet count to spleen diameter ratio (PSR) was studied extensively as a noninvasive method of diagnosis for varices. The present study aimed to systematically assess the performance of PSR in the diagnosis of varices. PubMed, EMBASE, and article references were searched. The summary receiver operating characteristic curves (AUSROCs), sensitivities, specificities, positive and negative likelihood ratio, and diagnostic odds ratio were calculated. The heterogeneity, quality, and publication bias of studies were evaluated. Subgroup and sensitivity analyses were performed. A total of 49 papers were included. The AUSROCs of PSR for any varices and high-risk varices were 0.8719 and 0.8132, respectively. The summary sensitivities of PSR for any varices and high-risk varices were 0.84 and 0.78, respectively. The summary specificities of PSR for any varices and high-risk varices were 0.78 and 0.67, respectively. The AUSROC of PSR for any varices at the threshold of 909 was 0.8867. The AUSROC of PSR for any varices in viral liver cirrhosis was 0.8675. The overall quality of studies was moderate. Significant heterogeneity and publication bias existed in the study. In conclusion, PSR can be used to identify varices in liver cirrhosis. PSR had a high sensitivity in viral liver cirrhosis.

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“…Majority (45.0%) of patients in the series had medium size EV followed by 27.0% had small and 19.0% patients had large EV. Agha et al 12 showed 72.0% patients had endoscopic evidence of EV. In this study, EV were found in more patients may be due to late presentation of the patients to the hospital.…”

Section: Discussionmentioning

confidence: 98%

“…Agha et al 12 found that platelet count/spleen diameter ratio <885 had 100% sensitivity (89-100, 95% confidence interval [CI]), 92% specificity (62-99, 95% CI), 12.0 positive likelihood ratio, and 0.01 negative likelihood ratio for the diagnosis of EV. Accuracy of the platelet count/spleen diameter ratio cut-off value as evaluated by the c-index was 0.989 (95% CI 0.897-0.992).…”

Section: Discussionmentioning

confidence: 99%

Screening of Esophageal Varices by Noninvasive Means in Chronic Liver Disease

Hossain

Ahammed

Saha

et al. 2018

Euroasian Journal of Hepato-Gastroenterology

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IntroductionNoninvasive assessment of esophageal varices (EV) decreases the medical and financial burden related to screening and helps in the management of patients with chronic liver diseases (CLDs). In this study, our aim was to assess the utility of the platelet count/spleen diameter index for the noninvasive evaluation of EV.Materials and methodsIn this cross-sectional observational study, a total of 100 CLD patients underwent screening endoscopy for EV in Medicine and Gastroenterology Department, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh. Platelet count/spleen diameter ratio was assessed in all patients and its diagnostic implication was calculated.ResultsUpper gastrointestinal endoscopy revealed that 45 (45.0%) patients had medium EV followed by 27 (27.0%) that had small EV and 19 (19.0%) patients had large EV. Receiver operator characteristic (ROC) curve was constructed using platelet count/spleen index, which gave a cut-off value of >905. The validity of platelet count/spleen index evaluation of CLD was: Sensitivity 92.3%, specificity 66.7%, accuracy 90.0%, positive predictive value (PPV) and negative predictive value (NPV) were 96.6 and 46.2% respectively. True positive was 84 cases, false positive 3 cases, false negative 7 cases, and true negative 6 cases. If we consider cut-off value as 909 in the evaluation of EV in CLD, then true positive was 85 cases, false positive 3 cases, false negative 6 cases, and true negative 6 cases. From this, by calculation, sensitivity was 93.4%, specificity 66.7%, accuracy 91%, PPV 96.6%, and NPV 50%.ConclusionThe platelet count/spleen index may be proposed to be a safe and reliable mean of screening of EV in CLD patients; however, case-control study would be required to validate this.How to cite this article: Hossain E, Ahammed F, Saha SK, Foez SA, Rahim MA, Noor-e-Alam SM, Abdullah AS. Screening of Esophageal Varices by Noninvasive Means in Chronic Liver Disease. Euroasian J Hepato-Gastroenterol 2018;8(1):18-22.

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Use of the platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices in patients with schistosomiasis

Cited by 19 publications

References 33 publications

Correlation of platelets count with endoscopic findings in a cohort of Egyptian patients with liver cirrhosis

Correlation of platelets count with endoscopic findings in a cohort of Egyptian patients with liver cirrhosis

Platelet Count to Spleen Diameter Ratio for the Diagnosis of Gastroesophageal Varices in Liver Cirrhosis: A Systematic Review and Meta-Analysis

Screening of Esophageal Varices by Noninvasive Means in Chronic Liver Disease

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