ROLE OF PLATELET COUNT/SPLEEN DIAMETER RATIO IN PREDICTING OESOPHAGEAL VARICES IN PATIENTS WITH LIVER CIRRHOSIS

Abstract

Cirrhosis remains a significant health burden to the world because of its relationship with portal hypertension and associated complications, notably oesophageal varices, which come with significant morbidity and risk of mortality. The diagnostic tool reference for variceal diagnosis is that of the endoscopic examination but is both invasive and expensive, with limited accessibility especially in low- to moderate-income countries. This was a prospective cross-sectional study carried out at the Jinnah Postgraduate Medical Centre, Karachi from June 2024 to May 2025. Consecutive inclusion of 250 adult patients with cirrhosis could be enrolled to avoid selection bias, which was according to AASLD criteria. Patients underwent a clinical examination, laboratory analysis including ultrasonographic measurement of spleen size, and platelet count, and then diagnostic endoscopy within 1 week. ROC curves were derived to estimate diagnostic accuracy at various cutoffs. The mean PC/SD ratio of patients with varices (542 ± 233) was significantly lower than those without varices (956 ± 271) (P <.001). At a cut-off of ≤ 900, the ratio predicted varices with sensitivity 85.2% and specificity 80.9% and VNT with sensitivity 92.2% and specificity of 77.1% (AUC -0:90). These data also support the influence of test type and assay method in relation to cutoff value as well as a good performance of PC/SD ratio with a cutoff ≤900 offering the best compromise between sensitivity and specificity in this sample. The findings validate its integration in standard clinical practice for minimizing excess endoscopies and resource allocation in resource-scarce healthcare systems.