Platelet Count as a Non-invasive Predictor of High-grade Esophageal Varices in Patients with Portal Hypertension: A Cross-sectional Study from Sudan

Abstract

Background: Oesophageal varices are a life-threatening complication of portal hypertension. While endoscopy is the gold standard for diagnosis, it is invasive and resource-intensive. Aims: This study aimed to evaluate the correlation between platelet count and the endoscopic grade of oesophageal varices and to determine its predictive value in a Sudanese cohort. Methods: A prospective, cross-sectional study was conducted at Al-Qadarif Teaching Hospital from December 2024 to February 2025. Eighty consecutive patients with portal hypertension undergoing upper gastrointestinal endoscopy were enrolled. Demographic, clinical, and laboratory data were collected. The relationship between platelet count and variceal grade was analysed using the chi-square test. Predictive values were calculated for a platelet count threshold of <150,000/µL. Results: A highly significant inverse correlation was found between platelet count and the grade of oesophageal varices (p = 0.000). Patients with platelet counts <50,000/µL predominantly had Grade 4 varices (82.1%), whereas all patients with a normal platelet count (>150,000/µL) had only Grade 1 varices. Using a platelet count of <150,000/µL to predict high-grade varices (Grades 3 and 4) yielded a positive predictive value (PPV) of 78.6% and a negative predictive value (NPV) of 100%. Conclusion: Platelet count demonstrates a strong inverse correlation with the severity of oesophageal varices. A normal platelet count effectively ruled out high-grade varices in this population. Platelet count is a simple, valuable, non-invasive tool for risk stratification in cirrhotic patients, particularly in resource-limited settings where access to endoscopy is constrained.