Platelet Count/Spleen Diameter Ratio in Predicting the Presence of Oesophageal Varices in Patients with Cirrhosis

A prospective study 1 included 266 patients (mean age 62 y, 68% men) with cirrhosis referred for staging of liver disease. 145 patients were included in the derivation set and 121 in the validation set. Platelet count/spleen diameter ratio (PC/SD ratio) was the only variable that independently predicted presence of oesophageal varices (OV). When the platelet count was given in n/mm³ and spleen diameter in mm, a PC/SD ratio cutpoint of 909 (for presence of OV) was estimated from the corresponding receiver-operating characteristics curve. Classification using the decision rule was compared with a definitive diagnosis of OV from endoscopy. In derivation set the sensitivity was 100% and the specificity was 93%. In the validation set, the sensitivity was 100% and the specificity was 42%. In 145 patients with compensated cirrhosis (from both sets) the sensitivity was 100% and the specificity was 71%. In this group, all patients with PC/SD > 909 were free of OV, whereas 74% of patients with PC/SD at or below 909 had OV.

The following decision support rules contain links to this evidence summary:

• Diagnosing esophageal varices in patients with cirrhosis http://www.ebmeds.org/ebmeds/ebmeds_home.asp?mode=scripts&submode=view&id=scr00553&country=UK

References

• Giannini E, Botta F, Borro P, Risso D, Romagnoli P, Fasoli A, Mele MR, Testa E, Mansi C, Savarino V, Testa R. Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis. Gut 2003 Aug;52(8):1200-5. [PubMed]