Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 27, 2024; 16(10): 1177-1187
Published online Oct 27, 2024. doi: 10.4254/wjh.v16.i10.1177
Platelet counts to spleen diameter ratio: A promising noninvasive tool for predicting esophageal varices in cirrhosis patients
Getnet Yigzaw Mossie, Abdulsemed Mohammed Nur, Zekarias Seifu Ayalew, Gebeyehu Tessema Azibte, Kaleb Assefa Berhane
Getnet Yigzaw Mossie, Zekarias Seifu Ayalew, Gebeyehu Tessema Azibte, Department of Internal Medicine, Addis Ababa University, Addis Ababa 1000, Ethiopia
Abdulsemed Mohammed Nur, Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa 1000, Ethiopia
Kaleb Assefa Berhane, Department of General Medicine, Adera Medical and Surgical Center, Addis Ababa 1000, Ethiopia
Co-corresponding authors: Getnet Yigzaw Mossie and Zekarias Seifu Ayalew.
Author contributions: Mossie GY and Nur AM contributed to conceptualization, investigation, analysis, writing of the manuscript and validation of the research; Mossie GY, Nur AM, Ayalew ZS, Azibte GT, and Berhane KA contributed to methodology of the research; Ayalew ZS, Azibte GT, and Berhane KA performed data curation, drafting, interpretation, edition, and supervision; All authors revised the manuscript and have approved the final version of the manuscript; Mossie GY and Ayalew ZS contributed equally to this study as corresponding and co-corresponding authors in designing the study, data analysis, and data interpretation; Mossie GY conceptualized and designed the study, prepared the questionnaire, and supervised the process of this project; Ayalew ZS prepared the proposal; he searched for literature and played an enormous role in getting the IRB from the institution. He was also responsible for re-analysis after the first peer review; The collaboration between Mossie GY and Ayalew ZS was critical for the completion of this project.
Institutional review board statement: The study was conducted by the Declaration of Helsinki and approved by the Institutional Review Board of Addis Ababa University, College of Health Sciences, protocol code 92/23 on 01/07/2023.
Informed consent statement: Informed consent was obtained from all subjects involved in the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The authors confirm that the data supporting the findings of this study are available within the article.
STROBE statement: The authors have read the STROBE statement checklist of items, and the manuscript was prepared and revised according to the STROBE Statement checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Getnet Yigzaw Mossie, MD, Assistant Professor, Department of Internal Medicine, Addis Ababa University, Churchill Street, Addis Ababa 1000, Ethiopia. yig2008gondar@gmail.com
Received: May 17, 2024
Revised: August 21, 2024
Accepted: September 6, 2024
Published online: October 27, 2024
Processing time: 156 Days and 18.7 Hours
Abstract
BACKGROUND

Liver cirrhosis is the end stage of progressive liver fibrosis as a consequence of chronic liver inflammation, wherein the standard hepatic architecture is replaced by regenerative hepatic nodules, which eventually lead to liver failure. Cirrhosis without any symptoms is referred to as compensated cirrhosis. Complications such as ascites, variceal bleeding, and hepatic encephalopathy indicate the onset of decompensated cirrhosis. Gastroesophageal varices are the hallmark of clinically significant portal hypertension.

AIM

To determine the accuracy of the platelet count-to-spleen diameter (PC/SD) ratio to evaluate esophageal varices (EV) in patients with cirrhosis.

METHODS

This retrospective observational study was conducted at Tikur Anbessa Specialized Hospital and Adera Medical Center from January 1, 2019, to December 30, 2023. Data were collected via chart review and direct patient interviews using structured questionnaires. The data were exported to the SPSS software version 26 for analysis and clearance. A receiver operating characteristic curve was plotted for splenic diameter, platelet count, and PC/SD ratio to obtain sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio.

RESULTS

Of the 140 participants, 67% were men. Hepatitis B (38%) was the most common cause of cirrhosis, followed by cryptogenic cirrhosis (28%) and hepatitis C (16%). Approximately 83.6% of the participants had endoscopic evidence of EV, whereas 51.1% had gastric varices. Decompensated cirrhosis and PC were associated with the presence of EV with adjusted odds ratios of 12.63 (95%CI: 3.16-67.58, P = 0.001) and 0.14 (95%CI: 0.037-0.52, P = 0.004), respectively. A PC/SD ratio < 1119 had a sensitivity of 86.32% and specificity of 70% with area under the curve of 0.835 (95%CI: 0.736-0.934, P < 0.001).

CONCLUSION

A PC/SD ratio < 1119 predicts EV in patients with cirrhosis. It is a valuable, noninvasive tool for EV risk assessment in resource-limited settings.

Keywords: Cirrhosis, Esophageal varices, Portal hypertension; Platelet count; Splenic diameter

Core Tip: Esophageal varices are a serious complication of liver cirrhosis. This study evaluated the platelet count-to-spleen diameter ratio as a non-invasive predictor of these varices in Ethiopian patients. We found a ratio below 1119 accurately identified at-risk patients, outperforming platelet count and spleen diameter alone. This ratio could be a valuable screening tool in resource-limited settings, but further research is needed to confirm its effectiveness.