Utilization of platelet count spleen diameter ratio in predicting the presence of esophageal varices in patients with cirrhosis

GOALS: To assess whether the platelet count/spleen diameter ratio is a useful noninvasive predictor of esophageal varices. BACKGROUND: Current guidelines recommend that all patients with cirrhosis undergo screening endoscopy for the presence of varices. Recent studies have focused on using noninvasive techniques to stratify cirrhotic patients according to their risk of having varices. One study examining the platelet count/spleen diameter ratio using a cut-off value of 909, yielded a negative predictive value of 100% for the presence of varices. STUDY: A retrospective analysis of 137 patients with cirrhosis over the age of 18 that underwent screening endoscopy for varices between January 2003 and October 2005. The data collected were age, sex, etiology of cirrhosis, spleen diameter, prothrombin time/international normalized ratio, total bilirubin, platelet count, albumin, Child-Pugh score, and endoscopic findings. RESULTS: There were 137 patients with 87 (63.5%) men and a mean age of 56 years. Seventy-six (55%) patients had esophageal varices. The mean age, sex, and etiology of cirrhosis were similar between those with and without varices. Using a platelet count/spleen diameter ratio with a cut-off value of 909, yielded a negative predictive value of only 73% and a positive predictive value of 74%. CONCLUSIONS: The platelet count/spleen diameter ratio with a cut-off value of 909 may not be sufficiently accurate in predicting the presence of esophageal varices. Upper endoscopy remains the method of choice to screen for the presence of varices.