A STUDY OF ROLE OF PLATELET COUNT/SPLEEN DIAMETER RATIO AS A PREDICTOR OF ESOPHAGEAL VARICES IN PATIENT WITH CHRONIC LIVER DISEASE

Abstract

Background: In patients of chronic liver disease, the parameters directly linked to portal hypertension such as splenomegaly and decreased platelet count were predictors of presence of esophageal varices. The present study was conducted with an objective to find out the predictive efficacy of platelet count / spleen diameter ratio to predict esophageal varices.

Materials and Methods: This is a cross sectional study conducted on cases of chronic liver disease using designed data collection protocol. Information about demographic and clinical profile, laboratory parameters, USG and Upper GI endoscopy were collected. Maximum spleen diameter was determined and bipolar spleen diameter was expressed in millimeter (mm). Platelet count/spleen diameter ratio was collected and compared with the presence/absence of esophageal varices.

Results: It was observed that 71.4% cases of chronic liver disease caused by Hepatitis B and 87.5% cases of Hepatitis C were having Platelet count/spleen diameter ratio of more than/equal to 909. Sensitivity and specificity of platelet count/spleen diameter ratio for detecting esophageal varices was 98.6% and 96%. Negative predictive value of platelet count / spleen diameter ratio to rule out esophageal varices in chronic liver disease patients was 96% positive predictive value was 98.6%. As the child Pugh class advances from A to C (more decompensation) percentage of patients developing esophageal varices increases with p-value < 0.001 which is highly significant.

Conclusion: Platelet count / spleen diameter ratio is a strong parameter which is independently associated with the presence of esophageal varices in chronic liver disease and irrespective of the etiology.