RÉSUMÉ
Background: Esophageal variceal bleeding is a clinical emergency and the major cause of death in patients with liver cirrhosis.Aims: To assess the value of platelet count (PC)/spleen diameter (SD) ratio in predicting the presence of esophageal varices (EV) in patients with HBV-related cirrhosis in China.Methods: A total of 91 consecutive HBV-related cirrhosis patients with EV from Aug.2013 to Dec.2015 at Renji Hospital (South Campus),School of Medicine,Shanghai Jiao Tong University were enrolled.Thirty-two HBV-related cirrhosis patients without EV were enrolled as controls.Upper gastrointestinal endoscopy,routine laboratory examinations and abdominal ultrasonography were performed and the related parameters were collected.Binary Logistic regression analysis was carried out to identify independent risk factors associated with EV.ROC curve was used to evaluate the predictive performance of PC/SD ratio for the presence of EV.Results: The PC/SD ratio was significantly lower in EV group than in non-EV group (538.2±327.0 vs.1 105.9±426.6,P=0.001).Binary Logistic regression analysis showed that the PC/SD ratio was independently associated with the presence of EV (OR=57.29,95％ CI: 15～214,P=0.000).In ROC curve analysis,the area under the curve (AUC) of PC/SD ratio in predicting the presence of EV was 0.853;the optimal cutoff value was 842,and the sensitivity,specificity,positive predictive value and negative predictive value were 85.7％,75.0％,90.7％,and 64.9％,respectively.Conclusions: PC/SD ratio can be used as a non-invasive tool for prediction of the presence of EV in patients with HBV-related cirrhosis.It may reduce the number of unnecessary endoscopy.
RÉSUMÉ
OBJETIVO: Evaluar el índice número de plaquetas/diámetro mayor del bazo (P/DMB) como un método diagnóstico no invasivo de la presencia de várices esofágicas (VE) en pacientes con cirrosis hepática.MATERIAL Y MÉTODOS: Estudio de Test Diagnósticos, análisis retrospectivo. Se recolectaron los datos de pacientes, con el diagnóstico de cirrosis hepática, en el Servicio de Gastroenterología del Hospital Nacional Daniel Alcides Carrión (HNDAC), entre Septiembre 2010 y Enero 2011 posteriormente se calculó la sensibilidad, especificidad, valor predictivo positivo y negativo, razón de probabilidades positiva y negativa; utilizando a la endoscopía digestiva alta como patrón de oro.RESULTADOS: Se evaluaron los datos de 47 pacientes, la edad promedio fue de 60,74 años; la etiología fue consumo de alcohol en el 25,5%, y no determinada en el 48,9% de pacientes. El 25% de pacientes no presentaron VE y 74,5% las presentaron. El índice P/DMB se comparó con la endoscopía, encontrándose una Sensibilidad de 40%, Especificidad de 75%, Valores predictivos positivo y negativo de 82% y 30% respectivamente; y razón de probabilidades positiva y negativa de 1,6 y 0,8 respectivamente. CONCLUSIONES: El índice P/DMB no es una prueba diagnóstica efectiva para el diagnóstico de la presencia de VE en la muestra estudiada.
AIM: To evaluate the platelet count/spleen diameter (PC/SD) ratio as a non invasive diagnostic test to predict esophageal varices (VE) in patients with cirrhosis. METHODS: Diagnostic test study, retrospective analysis. Data was collected from patients with diagnosis of liver cirrhosis at gastrointestinal unit of Hospital Nacional Daniel Alcides Carrión between September 2010 and January 2011. Using a PC/SD ratio with a cut off value of 909, sensitivity, specificity, Positive and negative predictive values, positive and negative likelihood ratios were calculate. RESULTS: There were 47 patients; mean age of 60,74; etiology: alcoholic (25,5%); undeterminated (48,9%). Twenty-five percent patients had varices and 74,5% had no varices. The PC/SD ratio had a sensitivity of 40%, specificity of 75%, PPV of 82%, NPV 30%, LR (+) of 1,6 and LR (-) of 0,8. CONCLUSIONS: The PC/SD ratio was not an effective diagnostic test for esophageal varices.