title: Platelet count is not a predictor of the presence or development of gastroesophageal varices in cirrhosis.
abstract: Current guidelines recommend esophagogastroduodenoscopy (EGD) in patients with cirrhosis to screen for gastroesophageal varices (GEV). Thrombocytopenia has been proposed as a noninvasive test to predict the presence of GEV. There is no agreement regarding a specific platelet count (PLT) that can reliably predict GEV. The present longitudinal study aims to (1) further investigate the relationship between varices and PLT at the time of endoscopy, (2) investigate whether changes in PLT from the baseline over time can predict the development of GEV, and (3) investigate whether changes in PLT correlate with the hepatic venous pressure gradient (HVPG). A secondary analysis was conducted for 213 subjects with compensated cirrhosis with portal hypertension but without GEV enrolled in a randomized, placebo-controlled, double-blind trial of a nonselective beta-blocker used to prevent GEV. PLTs were obtained every 3 months, and HVPG measurements and EGD were done annually. The PLTs were compared between subjects who did and did not develop GEV. In a median follow-up of 54.9 months, 84 patients developed GEV. PLT was greater than 150,000 in 15% of patients at the development of GEV. A receiver operating curve did not show any PLT with high sensitivity or specificity for the presence of GEV. Subjects with clinically insignificant portal hypertension (HVPG < 10 mm Hg) whose PLT remained greater than 100,000 had a 2-fold reduction in the occurrence of GEV (P = 0.0374). A significant correlation was found between HVPG and PLT at the baseline, year 1, and year 5 (P < 0.0001).
  
  
  CONCLUSIONS
  Cross-sectional or longitudinal evaluations of PLTs are inadequate noninvasive markers for GEV. Patients with mild portal hypertension whose PLT remains greater than 100,000 have significantly less risk of GEV. Although HVPG correlates somewhat with PLT, changes in PLT cannot be used as a surrogate for HVPG changes.
authors.affiliation: Brigham and Women's Hospital, Boston, MA 02446, USA. aqamar@partners.org
authors.forename: Amir A
authors.initials: AA
authors.lastname: Qamar
authors.forename: Norman D
authors.initials: ND
authors.lastname: Grace
authors.forename: Roberto J
authors.initials: RJ
authors.lastname: Groszmann
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Garcia-Tsao
authors.forename: Jaime
authors.initials: J
authors.lastname: Bosch
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Burroughs
authors.forename: Rie
authors.initials: R
authors.lastname: Maurer
authors.forename: Ramon
authors.initials: R
authors.lastname: Planas
authors.forename: Angels
authors.initials: A
authors.lastname: Escorsell
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Garcia-Pagan
authors.forename: David
authors.initials: D
authors.lastname: Patch
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Matloff
authors.forename: Robert
authors.initials: R
authors.lastname: Makuch
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004932:Esophageal and Gastric Varices / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008875:Middle Aged; D008954:Models, Biological; D010976:Platelet Count; D017082:Portal Pressure