Sreenivasan Sreenath1, Santhoshkumar Thulaseedharan Saraswathy2, Vijayalekshi Sundaresan Anoop3
BACKGROUND
Varices can be seen anywhere in the gastrointestinal tract. Distal end of oesophagus is one of the commonest sites. About 50% of cirrhotic patients develop oesophageal varices of which only 5-35% is gastric varices. Rest 70% are oesophageal varices.
The aim of this study is to identify non-endoscopic parameters that could predict the presence and grade of oesophageal varices and to assess platelet count:splenic size ratio as a predictor of high-grade oesophageal varices.
MATERIALS AND METHODS
After obtaining institutional approval, 300 consenting patients satisfying the inclusion criteria were enrolled in this study. Demographic, clinical, biochemical and ultrasonographic parameters were recorded by structured questionnaire. Oesophageal varices were classified as low grade and high grade at endoscopy data analysis was done using SPSS software. Tests of significance, ROC curves and bivariate logistic regression analysis were done to find out any relation with presence of high-grade varices and these noninvasive parameters.
RESULTS
Platelet count, spleen size, portal vein diameter and platelet count:spleen size ratio were the variables that showed significant difference between the two groups. Area under curve is significant for platelet count (0.823) and platelet count:spleen size ratio (0.845), spleen size (0.753) and portal vein diameter (0.623). The cutoff values were set and platelet count <90500, (sensitivity of 70.71% and specificity of 83.12%), portal vein diameter >12.05 mm (sensitivity - 67.86% and specificity - 51.25%), spleen size >12.45 cm (sensitivity - 80.71% and specificity - 64.38%) and platelet count:spleen size ratio less than 728.2 (sensitivity of 71.43% and specificity - 87.50%) could predict presence of high-grade varices.
CONCLUSION
Platelet count, splenic size, portal vein diameter and platelet count:spleen size ratio can be used in predicting the presence of high-grade oesophageal varices in patients with liver cirrhosis.
