title: Platelet count/spleen diameter ratio: analysis of its capacity as a predictor of the existence of esophageal varices.
abstract: BACKGROUND
  Upper gastrointestinal bleeding associated to esophageal varices is the most dramatic complication of cirrhosis. It is recommended screening every cirrhotic for esophageal varices with endoscopy.
  
  
  OBJECTIVE
  To evaluate the capacity of the platelet count/spleen diameter ratio in non-invasively predicting esophageal varices in a population of cirrhotics originated in an independent center from the one in which it was developed.
  
  
  METHODS
  The study included patients from the ambulatory care clinic of cirrhosis of a Brazilian hospital and studied platelet count, spleen diameter and presence of esophageal varices, as well as Child and MELD scores. It used a cutoff value of 909 for the platelet count/spleen diameter ratio, as previously published. A sample of 139 patients was needed to grant results a 95% confidence level.
  
  
  RESULTS
  The study included 164 cirrhotics, 56.7% male, with a mean age of 56.6 ± 11.6 years. In the univariate analysis, platelet count, spleen diameter, presence of ascites, Child and MELD scores and the platelet count/spleen diameter ratio were related to esophageal varices (P<0.05). The platelet count/spleen diameter ratio had sensitivity of 77.5% (95% CI = 0.700-0.850), specificity of 45.5% (95% CI = 0.307-0.602), positive predictive value of 79.5% (95% CI = 0.722-0.868), negative predictive value of 42.6% (95% CI = 0.284-0.567) and accuracy of 68.9% (95% CI = 0.618-0.760). In the multivariate analysis, platelet count was the only variable which related to esophageal varices (P<0.05).
  
  
  CONCLUSIONS
  Platelet count/ spleen diameter ratio is not adequate to predict esophageal varices in cirrhotics.
authors.affiliation: Universidade Federal de Ciências da Saúde de Porto Alegre, RS, Brazil. angmattos@hotmail.com
authors.forename: Angelo Zambam de
authors.initials: AZ
authors.lastname: Mattos
authors.forename: Angelo Alves de
authors.initials: AA
authors.lastname: Mattos
authors.forename: Fernanda Farias
authors.initials: FF
authors.lastname: Vianna
authors.forename: Maiara Isabel
authors.initials: MI
authors.lastname: Musskopf
authors.forename: Júlio Carlos
authors.initials: JC
authors.lastname: Pereira-Lima
authors.forename: Antônio Carlos
authors.initials: AC
authors.lastname: Maciel
mesh_terms: D001938:Brazil; D004932:Esophageal and Gastric Varices / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010976:Platelet Count; D011237:Predictive Value of Tests; D013154:Spleen / Q000473:pathology*