Prevention of First Bleeding Episode from Gastroesophageal Varices in Patients with Cirrhosis

Naveed  Aslam; Fawad Iqbal  Janjua; Najam Us Sehar; Safana  Sadaf; Salman  Javed; Muhammad Kamran  Farooq; Mehwish  Mustafa

doi:10.29054/apmc/2023.1317

Naveed Aslam Senior Registrar, Department of Gastroenterology, Gujranwala Teaching Hospital, Gujranwala Pakistan
Fawad Iqbal Janjua Assistant Professor, Department of Gastroenterology, Gujranwala Teaching Hospital, Gujranwala /GMC, Gujranwala Pakistan
Najam Us Sehar Assistant Professor, Department of Gastroenterology, Gujranwala Teaching Hospital, Gujranwala / GMC, Gujranwala Pakistan
Safana Sadaf Assistant Professor, Department of Histopathology, Shalamar Medical and Dental College, Lahore Pakistan
Salman Javed Assistant Professor, Department of Gastroenterology, Services Hospital Lahore/SIMS, Lahore Pakistan
Muhammad Kamran Farooq Senior Registrar, Department of Gastroenterology, Sheikh Zayed Hospital, Rahim Yar Khan Pakistan
Mehwish Mustafa Consultant Hematologist, Infinity Heath Care Laboratories, Lahore Pakistan

DOI: https://doi.org/10.29054/apmc/2023.1317

Keywords: Cirrhosis, Varices, Platelet count to spleen diameter ratio

Abstract

Background: Cirrhotic patients with clinically significant portal hypertension (CSPH) have high risk of developing gastroesophageal varices and bleeding. Many invasive and non-invasive tests are used to diagnosis CSPH, hence gastroesophageal varices. Gastroscopy is gold standard, but invasive, costly and not free of complications. In this study, we investigated non-invasive tests platelets count to spleen diameter ratio value in cirrhotic patients, to assess correlation to gastroesophageal varices and their size. Objective: In this study, we evaluated whom patients actually needed endoscopy. To determine the diagnostic accuracy of noninvasive tests (platelet count, spleen length, and platelet count‐to‐spleen length ratio) to identify clinically significant portal hypertension (CSPH) and gastroesophageal varices of any size in adult patients with cirrhosis, irrespective of etiology. Study Design: cross sectional study. Settings: Gastroenterology Department of Gujranwala Teaching Hospital, Gujranwala Pakistan. Duration: January to December 2022. Methods: One hundred and ten patients were included. The endoscopy was performed in dedicated endoscopy suite of Gujranwala Teaching Hospital Gujranwala and cirrhotic patient was screened for varices and graded into low and high grade varices. Patient ultrasound was reviewed for spleen diameter and complete blood count for platelets count. Chi-square test was used to determine the relationship of grade of varices with gender. One way ANOVA test was used to compare the mean platelets count, spleen diameter and platelets count to spleen diameter ratio among patient with and without varices. Results: The cut-off value for the platelets to spleen diameter ratio 606.9 had the best sensitivity of 96.6% and specificity of 63.0% for exclusion of varices. Platelets to spleen diameter ratio had the best AUC (area under curve) value was 0.880 (95% CI (0.813-0.947, p<0.001) for exclusion of varices. Conclusion: In patients with compensated cirrhosis, the platelet count to spleen diameter ratio appears to be best noninvasive test for exclusion of varices. A cut off value 606.9 can be used clinically to avoid gastroscopy in significant proportions of cirrhotic patients.