Diagnostic Value of Platelet Count/Splenic Diameter Ratio Versus Other Non-invasive Markers in Predicting Oesophageal Varices among Patients with Liver Cirrhosis

Abstract

Background: Oesophageal varices are an important complication of portal hypertension in liver cirrhosis, while upper gastrointestinal endoscopy is invasive and may be difficult to access. This study evaluated the diagnostic value of the platelet count/splenic diameter ratio and other non-invasive markers for predicting oesophageal varices among patients with liver cirrhosis in Enugu, South-East Nigeria. Methods: A cross-sectional analytical study was conducted at the University of Nigeria Teaching Hospital and Enugu State University Teaching Hospital from 2021 to 2022. Participants underwent clinical evaluation, abdominal ultrasonography, laboratory testing and upper gastrointestinal endoscopy. Non-invasive indices included APRI, MELD-Na, platelet count, platelet count/splenic diameter ratio, Fibrosis-4, Child-Pugh score and class, and AST/ALT ratio. Diagnostic performance was assessed using area under the receiver operating characteristic curve analysis. Results: Of 92 cases studied, 72 had complete data. The mean age was 49.15±14.97 years, with 40–49 years as the modal age group (27.8%). Males constituted 68.1% of participants. Hepatitis B virus was the most common aetiological factor (45.8%), followed by alcohol (31.9%). The platelet count/splenic bipolar diameter ratio showed the best sensitivity and specificity among the evaluated markers, at 74.5% and 52.0%, respectively, and performed better in predicting larger than smaller grades of varices. Conclusion: The platelet count/splenic diameter ratio showed useful diagnostic performance as a readily obtainable non-invasive marker. It may support risk stratification where endoscopic access is limited, although upper gastrointestinal endoscopy remains the reference investigation for oesophageal varices.