Brief Article
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World J Gastroenterol. Feb 28, 2014; 20(8): 2079-2084
Published online Feb 28, 2014. doi: 10.3748/wjg.v20.i8.2079
Platelet count/spleen diameter ratio to predict esophageal varices in Mexican patients with hepatic cirrhosis
Alejandro González-Ojeda, Gabino Cervantes-Guevara, Manuela Chávez-Sánchez, Carlos Dávalos-Cobián, Susana Ornelas-Cázares, Michel Dassaejv Macías-Amezcua, Mariana Chávez-Tostado, Kenia Militzi Ramírez-Campos, Anaís del Rocío Ramírez-Arce, Clotilde Fuentes-Orozco
Alejandro González-Ojeda, Michel Dassaejv Macías-Amezcua, Mariana Chávez-Tostado, Kenia Militzi Ramírez-Campos, Anaís del Rocío Ramírez-Arce, Clotilde Fuentes-Orozco, Research Unit in Clinical Epidemiology, Specialties Hospital of the Western Medical Center, Medical Unit of High Specialty, Mexican Institute of Social Security, Guadalajara, CP 44340, Jalisco, México
Gabino Cervantes-Guevara, Gastroenterology Department, Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Guadalajara, CP 44280, Jalisco, México
Manuela Chávez-Sánchez, Carlos Dávalos-Cobián, Susana Ornelas-Cázares, Gastroenterology Department, Specialties Hospital of the Western Medical Center, Medical Unit of High Specialty, Mexican Institute of Social Security, Guadalajara, CP 44340, Jalisco, México
Author contributions: González-Ojeda A, Cervantes-Guevara G, Chávez-Sánchez M, Dávalos-Cobián C, Ornelas-Cázares S, Macías-Amezcua MD, Chávez-Tostado M, Ramírez-Campos KM, Ramírez-Arce AR, Fuentes-Orozco C participated in the protocol design, collection of clinical information, statistical analysis and were involved in editing the manuscript; González-Ojeda A, Cervantes-Guevara G, Chávez-Sánchez M, Dávalos-Cobián C, Ornelas-Cázares S, Fuentes-Orozco C were involved in the protocol design, identification and inclusion of candidates and performed the intervention.
Correspondence to: Clotilde Fuentes-Orozco, MD, PhD, Research Unit in Clinical Epidemiology, Specialties Hospital of the Western Medical Center, Medical Unit of High Specialty, Mexican Institute of Social Security, Avenida Belisario Dominguez 1000, Colonia Independencia, Guadalajara, CP 44340, Jalisco, Mexico. clotilde.fuentes@gmail.com
Telephone: +52-33-31230241 Fax: +52-33-36182760
Received: September 26, 2013
Revised: October 25, 2013
Accepted: November 3, 2013
Published online: February 28, 2014
Processing time: 152 Days and 21.8 Hours
Abstract

AIM: To validate whether the platelet count/spleen size ratio can be used to predict the presence of esophageal varices in Mexican patients with hepatic cirrhosis.

METHODS: This was an analytical cross-sectional study to validate the diagnostic test for hepatic cirrhosis and was performed between February 2010 and December 2011. Patients with a diagnosis of hepatic cirrhosis were included and stratified using their Child-Pugh score. Biochemical parameters were evaluated, and ultrasound was used to measure the longest diameter of the spleen. The platelet count/spleen diameter ratio was calculated and analyzed to determine whether it can predict the presence of esophageal varices. Upper gastrointestinal endoscopy was used as the gold standard. Sensitivity and specificity, positive and negative predictive values, and positive and negative likelihood ratios were determined, with the cutoff points determined by receiver-operating characteristic curves.

RESULTS: A total of 91 patients were included. The mean age was 53.75 ± 12 years; 50 (54.9%) were men, and 41 (45.0%) women. The etiology of cirrhosis included alcohol in 48 (52.7%), virally induced in 24 (26.3%), alcoholism plus hepatitis C virus in three (3.2%), cryptogenic in nine (9.8%), and primary biliary cirrhosis in seven (7.6%). Esophageal varices were present in 73 (80.2%) patients. Child-Pugh classification, 17 (18.6%) patients were classified as class A, 37 (40.6%) as class B, and 37 (40.6%) as class C. The platelet count/spleen diameter ratio to detect esophageal varices independent of the grade showed using a cutoff value of ≤ 884.3, had 84% sensitivity, 70% specificity, and positive and negative predictive values of 94% and 40%, respectively.

CONCLUSION: Our results suggest that the platelet count/spleen diameter ratio may be a useful tool for detecting esophageal varices in patients with hepatic cirrhosis.

Keywords: Platelet count/spleen diameter ratio; Esophageal varices; Hepatic cirrhosis; Hepatitis C virus; Mexican patients

Core tip: Using noninvasive parameters for high-risk esophageal varices may reduce the need for endoscopies. The ratio of platelet count/diameter of the spleen (PC/SD ratio) is the principal noninvasive predictor of esophageal varices for stratifying patients with cirrhosis. These parameters are easy to obtain, reproducible and noninvasive. In our study, the cutoff point for PC/SD ratio was lower than that reported in previous literature (< 884.3 and < 909, respectively), with a sensitivity of 84% and specificity of 70%. The differences are probably influenced by racial characteristics. The PC/SD ratio should be considered to identifying patients with esophageal varices.