Platelet Count to Splenic Diameter Ratio as a Predictor of Esophageal Varices in Patients with Chronic Liver Disease

Abstract

Background: Esophageal varices are a significant complication of chronic liver disease (CLD) and can lead to life-threatening hemorrhage. The gold standard for diagnosis is endoscopy, but this invasive procedure is not always accessible in resource-limited settings. This study evaluates the predictive value of platelet count to splenic diameter (PC) ratio as a non-invasive marker for esophageal varices in patients with CLD.

Methodology: This 18-months (May 1, 2023, to October 31, 2024) observational cross-sectional study included 156 patients with CLD in the General Medicine department at the National Institute of Medical Sciences & Research, Jaipur, Rajasthan. All subjects underwent clinical examination, laboratory investigations (including platelet count), abdominal ultrasonography to measure splenic diameter, and upper gastrointestinal endoscopy for detection and grading of esophageal varices. The predictive accuracy of platelet count, splenic diameter, and PC ratio were evaluated using ROC curve analysis.

Results: Of the 156 patients, 84 (53.8%) had esophageal varices, with Grade III varices being the most prevalent (51.2%). Patients with varices had significantly lower platelet counts (131,071.43 vs. 177,625.00/mm³, p=0.000), larger splenic diameters (138.77 vs. 116.40 mm, p=0.000), and lower PC ratios (1011.01 vs. 1591.42, p=0.000) compared to those without varices. ROC curve analysis revealed optimal cutoff values of 126,000/mm³ for platelet count (sensitivity 73.6%, specificity 82.4%), 144.14 mm for splenic diameter (sensitivity 78.2%, specificity 81.9%), and 947.54 for PC ratio (sensitivity 75.7%, specificity 84.7%).

Conclusion: The PC ratio and splenic diameter are reliable non-invasive predictors of esophageal varices in CLD patients. These parameters can help identify high-risk patients who require urgent endoscopic evaluation, potentially reducing the need for unnecessary invasive procedures and improving resource allocation, particularly in settings with limited access to endoscopy.