What is the accuracy of platelet count and platelet count/spleen length ratio for the diagnosis of esophageal varices in adults with chronic liver disease or portal vein hypertension?

2020 ◽  
Author(s):  
Jane Burch ◽  
Ulrich Ronellenfitsch
Keyword(s):  
Platelet Count ◽  
Liver Disease ◽  
Portal Vein ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Chronic Liver ◽  
Length Ratio ◽  
Portal Vein Hypertension

scholarly journals A72 NON-INVASIVE PREDICTION OF ESOPHAGEAL VARICES BY TRANSIENT ELASTOGRAPHY AND PLATELET COUNT IN PATIENTS WITH HEPATITIS B AND ADVANCED CHRONIC LIVER DISEASE: VALIDATION OF BAVENO VI AND EXPANDED BAVENO VI CRITERIA

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 37-38
Author(s):  
A Zoughlami ◽  
J Serero ◽  
G Sebastiani ◽  
M Deschenes ◽  
P Wong ◽  
...  
Keyword(s):  
Platelet Count ◽  
Liver Disease ◽  
Hepatitis B ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Diagnostic Performance ◽  
Transient Elastography ◽  
Chronic Liver ◽  
Non Invasive ◽  
Chronic Hepatitis B Virus

Abstract Background Patients with compensated advanced chronic liver disease (cACLD) are at higher risk of developing complications from portal hypertension, including esophageal varices (EV). Baveno VI and expanded Baveno VI criteria, based on liver stiffness measurement (LSM) by transient elastography combined with platelet count, have been proposed to avoid unnecessary esophagogastroduodenoscopy (EGD) screening for large esophageal varices needing treatment (EVNT). This approach has not been validated in patients with chronic hepatitis B virus (HBV) infection, who have etiology-specific cut-off of LSM for liver fibrosis. Aims We aimed to validate the Baveno VI and expanded Baveno VI criteria for EVNT in HBV patients with cACLD. Methods We performed a retrospective analysis of HBV patients who underwent LSM in 2014–2020. Inclusion criteria were: a) diagnosis of cACLD, defined as LSM >9 kPa; b) availability of EGD and platelets within 1 year of LSM. Baveno VI (LSM <20 kPa and platelets >150,000) and expanded Baveno VI criteria (LSM <25 kPa and platelets >110,000) were tested for EGD sparing. Diagnostic performance of these criteria against gold standard (EGD) was computed and compared to patients with hepatitis C virus (HCV) infection and nonalcoholic steatohepatitis (NASH) etiologies, where these criteria have been widely validated. In these patients, the threshold for cACLD definition was >10 kPa. Results A total of 287 patients (mean age 56, 95% Child A) were included, comprising of 43 HBV (58% on antiviral therapy), 134 HCV and 110 NASH patients. The prevalence of any grade EV and EVNT was 25% and 8% in the whole cohort, with 19% and 5% in HBV patients, respectively. Table 1 reports diagnostic performance, spared EGD and missed EVNT according to non-invasive criteria and cACLD etiology. Both Baveno VI and expanded Baveno VI criteria performed well in patients with HBV-related cACLD. There was no significant difference on diagnostic performance of these non-invasive criteria across the cACLD etiologies. Conclusions These results support use of non-invasive criteria based on LSM and platelets to spare unnecessary EGD in patients with HBV and cACLD. Baveno VI and expanded Baveno VI criteria can improve resource utilization and avoid invasive testing in context of screening EGD for patients with HBV-related cACLD. Funding Agencies None

scholarly journals Diagnostic accuracy of Platelet Count for prediction of Esophageal varices in patients presenting with Chronic Liver disease.

2020 ◽  
Vol 27 (01) ◽  
pp. 16-22
Author(s):  
Siraj ud Din Barech ◽  
Tahir Ullah Khan ◽  
Muhammad Niaz Khan
Keyword(s):  
Platelet Count ◽  
Liver Disease ◽  
Diagnostic Accuracy ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Invasive Procedure ◽  
Cross Sectional Study ◽  
Chronic Liver ◽  
Cross Sectional ◽  
Low Platelet Count

Thrombocytopenia increases the risk of bleeding in CLD patients. The determination of the presence of Esophageal Varices (EV) by endoscopy is an invasive procedure. As a noninvasive tool, low platelet count (PC) can be helpful in prediction of variceal bleed in CLD patients with esophageal varices. Objectives: To assess the diagnostic accuracy of thrombocytopenia in predicting the presence of esophageal varices in patients with chronic liver disease. Study Design: Descriptive Cross sectional study. Setting: Medicine Unit I, Sheikh Zayed Hospital, Lahore. Period: 6 months from 1-07-2015 to 31-12-2015. Material and Methods: About 150 cases were included in our study through Non-Probability, Consecutive sampling method after obtaining written Informed consent. Blood sample was obtained from each patient and were immediately sent to the laboratory for assessment of platelet count. Reports were assessed. Those with low platelet count were referred to endoscopy room for confirmation of esophageal varices. Reports of endoscopy were compared with platelet count. Data was entered and analyzed through SPSS version 23. Results: Mean age of patients was 49.64±11.54 years. There were 97(64.7%) male and 53(35.3%) female patients. Mean duration of chronic liver disease of patients was 3.51±1.39. Mean platelet count of patients was 172.3±81.20. Sensitivity and Specificity of Thrombocytopenia for prediction of esophageal varices in patients presenting with chronic liver disease was 92.63% and 89.09%. While PPV, NPV and Diagnostic accuracy of Thrombocytopenia for prediction of esophageal varices was 93.62%, 87.5% and 91.33% respectively. Conclusion: It has been concluded from the present study that PC has high accuracy for detection of EVs and can be helpful in prediction of EVs in CLD patients.

scholarly journals Non-Invasive Predictors of Esophageal Varices in Alcoholic Chronic Liver Disease

2019 ◽  
Vol 8 (2) ◽  
pp. 15-20
Author(s):  
Rishab Shrestha ◽  
Alisha Rajbhandari ◽  
Pradip Chaudhary ◽  
Kausal Sigdel
Keyword(s):  
Platelet Count ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Alcoholic Liver Disease ◽  
Esophageal Varices ◽  
College Teaching ◽  
Diameter Ratio ◽  
Chronic Liver ◽  
Ethanol Ingestion ◽  
Non Invasive

Background: Alcohol is widely consumed socially accepted recreational beverage, that is toxic and affects directly or indirectly almost every organ. Spectrum of alcoholic liver disease ranges from fatty liver to cirrhosis. One of the complications of the later spectrum is portal hypertension, around 50% develops varices and bleeding depends on the size of the varices. Predicting varices without endoscopic is difficult but few non-invasive parameters are available. Materials and Methods: It was a prospective cross-sectional study done in Nobel Medical College Teaching Hospital, Biratnagar, Nepal from September 2018 to August 2019. Approval was acquired from Institutional Review Committee. Patients with chronic ethanol ingestion and features suggestive of chronic liver disease clinically and investigation wise were enrolled in the study. History, physical examinations along with platelet count, prothrombin time was taken and ultrasonography abdomen and upper gastrointestinal endoscopy was done to see the splenic diameter, and varices. Results: Esophageal varices were present in 53%. Mean platelet count with variceswas 122566 ± 36024.8 /mm3, splenic diameter was 133.1 ± 21.3 mm, prothrombintime (PT) time was 19.3 ± 5.0 sec andratio of platelet per spleen diameter was 930.2 ± 259.4 /mm3/mm.Platelet count < 163500/mm3 has sensitivity and specificity 83.0% and 83.0% respectively. Ratio of platelet per splenic diameter ratio cutoff 1293.7 has 88.7% sensitivity and 85.1% specificity for predicting varices. Conclusion: In chronic alcoholic liver disease patients low platelet count, increased splenicdiameter, low platelet per splenic diameter ratio are useful in predicting presence of esophageal varices.

scholarly journals Severity of thrombocytopenia with different grades of esophageal varices in chronic liver disease patients undergoing gastroscopy’s in a Tertiary Care Hospital.

2019 ◽  
Vol 26 (10) ◽  
pp. 1742-1747
Author(s):  
Raj Kumar Lohana ◽  
Riaz Hussain Awan ◽  
Seema Nayab ◽  
Khadim Hussain Awan ◽  
Faqir Muhammad Awan
Keyword(s):  
Platelet Count ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Chronic Liver ◽  
High Yield ◽  
Care Hospital ◽  
The Mean

Objectives: To correlate severity of thrombocytopenia with different grades of esophageal varices in chronic liver disease patients undergoing EGD in a tertiary care hospital. Study Design: Cross sectional study. Setting: Gastroenterology & Hepatology Department at Liaquat National. Period: Six months from Jan to June 2016. Material and Methods: Seventy six subjects of chronic liver disease were recruited and studied for correlation between platelet count and esophageal varices by gastroscopy while the data was analyzed in SPSS version 17. Period: From July 2016 to Dec 2016. Results: There were 55 (72.4%) males and 21 (27.6%) females. The mean age was 45.6 ± 14.7 years. 10 (13.2%) had Hepatitis B, 58 (76.3%) Hepatitis C, 01 (1.3%) Wilson’s disease, 03 (3.9%) Autoimmune disease and 04 (5.3%) Alcoholic liver disease. 09 (11.8%) had Child-Pugh Class A, 41 (53.9%) Class B and 26 (34.2%) had Class C. The mean platelet count was 85/µl ± 40.2/µl. Out of 76 patients 70 (92.1%) had esophageal varices. 23 (30.3%) had grade III varices, 19 (25%) had grade II, 14 (18.4%) each had grade I & IV and 06 (7.9%) had grade 0 varices. Conclusion: thrombocytopenia can predict the occurrence of esophageal varices in cirrhotic population while gastroscopy has high yield for varices.

scholarly journals Non-invasive parameters for the detection of variceal bleed in patients of liver cirrhosis, an experience of a tertiary care hospital in Pakistan

2014 ◽  
Vol 6 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Anam Umar ◽  
Fakhar Ali Qazi ◽  
Rukhsana Abdul Sattar ◽  
Beena Umar
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Portal Vein ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Chronic Liver ◽  
Care Hospital ◽  
Coagulation Profile ◽  
Variceal Bleed ◽  
Splenic Size

 Objective: Cirrhotic patients commonly undergo screening endoscopy for the existence of esophageal varices. The use of this invasive procedure which is expensive, poorly tolerable and generally not acceptable for the patients is increasing due to increasing number of patients with chronic liver disease and their enriched survival. In this study, our aim is to identify clinical, biochemical, and ultrasonography parameters which might non-invasively predict the presence of esophageal varices and risk of bleeding in patients with liver cirrhosis. Material and Methods: Total 150 Patientsof chronic liver disease admitted in ward-5, JPMC(Sep 2011-Feb 2012) with a complaint of hematemesis or melena were included in the study. Platelet counts of 75,000 to 150,000/μL was defined as grade 1 thrombocytopenia, 50,000 to <75,000/μL as grade II, 25,000 to <50,000/μL as grade III and below 25,000/μL as grade IV. The normal range for the INR is 0.8–1.2. Portal vein size of 1.2 cm or above was taken as dilated. Spleen of >13 cm was considered as enlarged in our study. Results: Out of 72 patients of variceal bleed 69 (46%) were males and 81(54%) were females. Thrombocytopenia was present in 64 (88%) patients with mean platelet count of 85.86/μL (±69.79). Deranged coagulation profile was present in 56 (77%) cases with mean INR of 1.63 (±0.5). Portal vein diameter (PVD) of >1.2 cm was found in 46(63.8%) of patients with mean PVD of 1.22(±0.3023) and splenic size of >13 cm was reported in 54 (75%) cases with mean splenic diameter of 14.5 cm (±2.39). Conclusion: Thrombocytopenia, deranged coagulation profile, large splenic size, and dilated portal vein strongly predict the risk of variceal bleeding. DOI: http://dx.doi.org/10.3126/ajms.v6i1.9624 Asian Journal of Medical Sciences Vol.6(1) 2015 61-66

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