Platelet Count/Spleen Diameter Ratio as a Non-invasive Parameter in the Prediction of Esophageal Varices in Patients with Liver Cirrhosis

Background: Esophagogastroduodenoscopy (EGD) is the gold standard for detecting oesophageal varices (OVs) in cirrhotic patients. However, due to the possible limitations of EGD, there has been much interest in the use of non-invasive techniques for this purpose. This study aimed to evaluate the use of platelet count/ spleen diameter ratio (PC/SD) in the prediction of the presence and grading of OVs in cirrhotic patients. 
Methods: One hundred cirrhotic patients were included in this cross-sectional study and subjected to EGD after informed consent. Either absence or the grade of OVs if existent was correlated with values of the PC/SD ratio. Univariate and multivariate analyses of data and areas under the receiver operating characteristic curve (AUC) were used. 
Results: The PC/SD ratio was a good indicator in predicting the development of OVs (AUC of 0.897) with cut-off values of (987.28). Also, it correlated well with grades of oesophageal varices, a significant stepwise progressive decrease in PC/SD ratio was recorded through the grades of oesophageal varices as follows: Mean ± SD (882.59±390.43) (603.33±266.99) (503.76±190.80) (439.69±22.51) for grades I, II, III and IV respectively (p <0.002),(AUC=0.688, 0.764, 0.795, 0.849) with a cut-off value of (784.37, 640.27, 597.50, 462.00) in grades I, II, III and IV respectively. 
Conclusion: The PC/SD ratio could be considered a non-invasive method of choice for screening OVs, sparing EGD for patients in need of intervention.