In patients with cirrhosis the endoscopic screening is indicated to verify the possible presence of esophageal varices, in order to start a preventive therapy with beta-blockers to avoid bleeding. Esophageal varices are associated with both thrombocytopenia and splenomegaly. In a previous study, Giannini and coll. had suggested that a platelet count associated with spleen diameter measurement could be a non-invasive alternative to endoscopy to identify the patients with a high risk of varices: a ratio higher than 909 (platelet count/mm3 divided by spleen diameter in mm) had a negative predictive value of 100%. Now, the same Italian researchers have evaluated the accuracy of this ratio in 218 subjects affected by cirrhosis related to various etiology. All had undergone endoscopy for the first time, with a confirmation of esophageal varices in 54% of patients. Cutoff at 909 showed to have a sensibility of 92% and a specificity of 67% with a positive predictive value of 77% and a negative predictive value of 87%.
A ratio platelets/spleen diameter higher than 909 excludes the presence of esophageal varices with an accuracy of 87%, while a diagram by the authors shows that rising the cutoff to 1400 one could obtain a negative predictive value of 100% (it is however true that few patients present these values). The platelet count and the spleen diameter measurement through echography represent however a valid non-invasive and low-cost help in esophageal varices diagnostics.
