Noas Tobias Minz, Ganeswar Sethy, Arjun Kuttikrishnan, Teena Thomas, Abinash Swain, Ranjit Kumar Rout
BACKGROUND Most cirrhotic patients will develop oesophageal varices over their lifetime and the annual rate of oesophageal haemorrhage is 5 to 15%. Current guidelines recommend using Upper Gastrointestinal Endoscopy (UGIE) to screen all cirrhotic patients at diagnosis for identification of varices at a high risk of bleeding. In a limited resources setting like ours where financial constraints are a major problem predicting the presence and grade of varices by non-invasive methods serves to help a lot in various ways. The aim of the study is to find out the relevance of platelet count-spleen diameter ratio as a non-invasive predictor of oesophageal varices in patients with hepatic cirrhosis. MATERIALS AND METHODS The present study was conducted on 100 patients admitted with a diagnosis of cirrhosis of liver in general medicine wards of M.K.C.G. Medical College, Brahmapur, during the period of 2 years. All the patients underwent detailed clinical evaluation, total platelet count, ultrasound abdomen and varices were graded by upper GI endoscopy with Paquet’s grading. Statistical Analysis- All data were entered in Excel 2007 and statistical analysis was performed using the statistical software SPSS 16.0. Data were expressed as frequency (in percentages), median values (with range (minimum, maximum)). For continuous variables, Mann-Whitney U test was performed to find the differences between two groups. Study Design- Cross-sectional analytic study. RESULTS 100 patients with hepatic cirrhosis were evaluated with upper GI endoscopy, ultrasound abdomen and total platelet count. Median platelet count in large varices group was 90,100 and in small varices group was 2 lakhs. Large varices were significantly correlated with increasing spleen size, median value - 182.5 mm. Platelet count-spleen diameter ratio was significantly low in patients with higher grade of oesophageal varices. CONCLUSION This study shows significant association between low platelet count, higher spleen size and lower platelet count-spleen diameter ratio with the presence of large oesophageal varices. These parameters can be used as non-invasive predictors of oesophageal varices in patients with hepatic cirrhosis, but never comparable with upper GI endoscopy in terms of sensitivity and specificity in prediction of variceal haemorrhage.
