Platelet count/bipolar spleen diameter ratio for the prediction of esophageal varices: the special Egyptian situation

Background: esophageal variceal hemorrhage is a devastating complication of portalhypertension that occurs in approximately one-third of cirrhotic patients.objectives: we assessed the value of the platelet count/ bipolar spleen diameter ratioas a noninvasive parameter for the prediction of esophageal varices (evs) in egyptiancirrhotic patients.patients and methods: laboratory and ultrasonographic and imaging variables wereprospectively evaluated in 175 patients with liver cirrhosis. all patients underwent uppergastrointestinal endoscopy. patients with active gastrointestinal bleeding at thetime of admission were excluded.results: the platelet count/ bipolar spleen diameter ratio in patients with evs was significantlylower than in patients without evs. in an analysis of the receiver operatingcharacteristic curves (rocs), we calculated an optimal cutoff value of 939.7 for this ratio,which gave 100% sensitivity and negative predictive values, 86.3% specificity, a 95.6%positive predictive value, and an area under the roc curve of 0.94 ± 0.02, reflectingits overall diagnostic accuracy. these findings were extended to a subset analysis ofcompensated cirrhotic patients.conclusions: the platelet count/ bipolar spleen diameter ratio has excellent accuracy inthe noninvasive assessment of evs in patients with compensated or decompensatedliver cirrhosis. it is easy to calculate and can lower the financial and sanitary burdensof endoscopy units, especially in developing countries.