Platelet counts to spleen diameter ratio: A promising noninvasive tool for predicting esophageal varices in cirrhosis patients

Table 1 Baseline sociodemographic and clinical characteristics of the study participants

Variables			Frequency	Percentage (%)	Median with IQR
Age (years)			-	-	40.5 (31-54)
Sex	Male		95	67.9	-
	Female		45	32.1	-
History of jaundice	Yes		47	33.6	-
	No		93	66.2	-
History of alcohol use	Yes		21	15	-
	No		119	85	-
Ascites	Yes		53	37.9	-
	No		87	62.1	-
Cirrhosis classification	Compensated		70	50	-
	Decompensated		70	50	-
HBsAg	Reactive		56	40	-
	Non-reactive		84	60	-
HCV Ab	Reactive		23	16.4	-
	Non-reactive		117	83.6	-
Ascites on ultrasounds	Yes		60	42.8	-
	No		79	56.4	-
	Not reported on ultrasound		1	0.7	-
EV on endoscopy	Yes	Grade 1	32	27.4	-
		Grade 2	47	40.2	-
		Grade 3	38	32.5	-
	No		23	16.4	-
Stigmata of bleeding	Yes		43	30.7	-
	No		81	57.8	-
	Not reported on the endoscopy		16	11.4	-

HBsAG: Hepatitis B surface antigen; HCV Ab: Hepatitis C virus Ab; EV: Esophageal varices; IQR: Interquartile range.

Table 2 Baseline biochemical and ultrasound findings of the study participants

Variables		Percentage of participants for whom the laboratory tests were done (%)	Median with IQR
AST (IU)		97.1	66 (41-119)
ALT (IU)		97.1	48.5 (32-79.9)
Total bilirubin (mg/dL)		86.4	1.5 (0.89-2.62)
Albumin (g/dL)		60.7	3.78 (3-4.15)
INR		37.8	1.45 (1.25-1.81)
Hemoglobin (g/dL)		100	13.65 (11.6-15.57)
WBC count (× 10³/mL)		100	5.0 (3.8-6.575)
Platelet count (× 10³/mL)		100	104 (73-139)
Creatinine (mg/dL)		90	0.8 (0.6-0.92)
Ultrasound findings	SD (mm)	100	140 (123-161.75)
	Liver size (mm)	100	140 (130-148)
	Portal vein diameter (mm)	37.8	12 (10-14.9)
PC/SD		100	750.88 (452.2-1099)

AST: Aspartate transaminase; ALT: Alanine transaminase; PC/SD: Platelet count-spleen diameter ratio; SD: Spleen diameter; INR: International normalized ratio; IQR: Interquartile range.

Table 3 Comparison of study participants' clinical, biochemical, and ultrasonographic features based on the presence or absence of esophageal varices

Variables		Cirrhosis with varices	Cirrhosis without varices	P value
Sex	Male	65.8%	78.3%	0.2431
	Female	64.2%	21.7%	-
Age		41 (31-53)	39 (30-55)	0.889
AST		67 (43.7-121.5)	41.5 (31-85.25)	0.035
ALT		47 (32-79.8)	51 (27.5-83)	0.96
WBC count		5 (3.7-6.55)	5.6 (4.5-6.8)	0.386
Hemoglobin		13.3 (11.25-15.1)	15.9 (14-16.4)	0.001a
Platelet count		94 (68-132)	159 (128-207)	0.001a
Ultrasound features	SD (mm)	141 (124-168)	125 (115-141)	0.001a
	Liver size (mm)	141 (130-148)	140 (130-147)	0.832
	PC/SD	693.8 (423.6-1053)	1360 (920-1886.9)	0.001a

^aP < 0.05.

¹P value was taken from the χ²; and the rest of the P value was taken from the man Withey test.

AST: Aspartate transaminase; ALT: Alanine transaminase; PC/SD: Platelet count-spleen diameter ratio; SD: Spleen diameter.

Table 4 The crude and adjusted odds ratio of variables in univariant and multivariate logistic regression

Variable	Crude OR (95%CI)	P value	AOR (95%CI)	P value
PC/SD	0.069 (0.025-0.195)	< 0.001	-	-
Hemoglobin	0.695 (0.551-0.875)	0.002	-	-
Platelet count	0.129 (0.036-0.56)	0.002	0.140 (0.037-0.526)	0.004a
SD	1.037 (10.13-1.061)	0.002	-	-
Ascites on ultrasound	0.044 (0.006-0.337)	0.003	-	-
Stage of cirrhosis	14.571 (3.264-65.055)	< 0.001	12.623 (3.164-67-586)	0.001a

^aP < 0.05.

OR: Odds ratio; AOR: Adjusted odds ratio; PC/SD: Platelet count-spleen diameter ratio; SD: Spleen diameter.

Table 5 Predictive accuracy of the best cutoff value of platelet count, spleen diameter, and platelet count-spleen diameter ratio in the diagnosis of esophageal varices

Non-invasive markers	Cut-off value	Sensitivity (%)	Specificity (%)	AUROC (95%CI)	P value	PPV (%)	NPV (%)	Accuracy (%)
Platelet count	138000/mL	82.05	69.57	0.815 (0.718-0.913)	< 0.001	93.20	43.24	80
Spleen diameter	120.5 mm	83.76	47.83	0.712 (0.605-0.820)	0.001	89.09	36.67	77.86
PC/SD	1118.74	86.32	69.57	0.835 (0.736-0.934)	< 0.001	93.52	50	83.57

AUROC: Area under the receiver operating characteristic curve; PC/SD: Platelet count-spleen diameter ratio; PPV: Positive predictive value; NPV: Negative predictive value.

Table 6 Predictive accuracy of the cutoff value of platelet count, spleen diameter, and platelet count-spleen diameter ratio in the diagnosis of compensated cirrhosis

Non-invasive marker	Cut-off value	Sensitivity (%)	Specificity (%)	AUROC (95%CI)	P value	PPV (%)	NPV (%)	Accuracy (%)
Platelet count	119500/mL	73.47	90.48	0.872 (0.785-0.959)	0.001a	94.74	59.38	78.57
Spleen diameter	133.5 mm	59.18	76.19	0.713 (0.591-0.836)	0.005	85.29	44.44	64.29
PC/SD	830.3	69.39	95.24	0.889 (0.805-0.973)	0.001a	97.14	57.14	77.14

^aP < 0.05.

AUROC: Area under the receiver operating characteristic curve; PC/SD: Platelet count-spleen diameter ratio; PPV: Positive predictive value; NPV: Negative predictive value.

Table 7 Predictive accuracy of the best cutoff value of spleen diameter and Platelet count-spleen diameter ratio in the diagnosis of large esophageal varices

Non-invasive marker	Cut-off value	Sensitivity (%)	Specificity (%)	AUROC (95%CI)	P value	PPV (%)	NPV (%)	Accuracy (%)
Spleen diameter	140.5 mm	78.95	60.76	0.695 (0.595-0.795)	0.001a	49.18	85.71	66.67
PC/SD	696.5	63.16	55.7	0.595 (0.488-0.702)	0.095	40.68	75.86	58.12

^aP < 0.05.

AUROC: Area under the receiver operating characteristic curve; PC/SD: Platelet count-spleen diameter ratio; PPV: Positive predictive value; NPV: Negative predictive value.