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Platelet count/splenic size ratio: a parameter to predict the presence of esophageal varices in cirrhotics.

OBJECTIVE
To evaluate platelet count/ splenic size ratio as a non-invasive parameter to predict the presence and absence of esophageal varices in patients with cirrhosis of liver.


DESIGN
An observational, cross- sectional study.


PLACE AND DURATION OF STUDY
The medical units of the Civil Hospital, Karachi, between October 2003 and October 2004.


PATIENTS AND METHODS
During one year of study, one hundred and thirteen (113) patients with cirrhosis of liver were studied. These patients were evaluated for the cause of chronic liver disease, ascites and splenic size by abdominal ultrasound, serum proteins and albumin, prothrombin time, complete blood count including platelet count and liver functions test. All the patients had upper GI endoscopy to determine if they had esophageal varices and were classified according to Child s-Pugh classification. It was determined if the platelet count/ splenic size ratio between the two groups was different and its relation to the presence or absence of esophageal varices was noted.


RESULTS
Of the one hundred and thirteen (113) patients included in the study, 35(31%) were female and 78(69%) male. The mean age of these patients was 37.1(+/- 14.85) years. Thirty-eight patients had HBsAg, 59 had anti-HCV antibodies, 8 patients had both HbsAg and anti-HCV antibodies and the cause of cirrhosis in 8 patients was indeterminate. Fifty patients had ascites. Of 113 patients, 15(13.27%) were classified as Child s Pugh class A, 68(60.18%) in class B and 30(26.55%) in class C. Sixty-six (58.4%) patients had esophageal varices on upper GI endoscopy while 47(41.6%) had no endoscopic evidence of esophageal varices. The ratio between platelet count/ splenic size was found to be significantly (p < 0.001) different between patients who had esophageal varices and those who did not.


CONCLUSION
Platelet count/splenic size ratio is an important and an independent parameter associated with the presence of esophageal varices.