External validation of the pPlatelet count/spleen diameter ratio for the diagnosis of esophageal varices in hepatitis C virus-related cirrhosis

Background Screening for esophageal varices (EV) is an important part of the diagnostic workup of cirrhotic patients. Aims To independently validate the use of the platelet count/spleen diameter ratio for the non-invasive diagnosis of EV in patients with HCV-related cirrhosis and in a sub-group of patients with compensated disease. Methods A platelet count/spleen diameter ratio cut-off value of 909 was evaluated for the diagnosis of EV in the whole population (n = 311) and in patients with compensated disease alone (n = 114). Compensated disease was defined as the absence of ascites as detected by abdominal ultrasound in patients who are not on diuretics and absence of hepatic encephalopathy. Results In the whole cohort (EV prevalence 49.5%), the platelet count/spleen diameter ratio 909 cut-off value had 96.9% positive predictive value, 100% negative predictive value, and 98.4% efficiency for EV diagnosis. In compensated cirrhotics (EV prevalence 26.3%), the platelet count/spleen diameter ratio 909 cut-off showed an excellent negative predictive value (100%) and a positive predictive value of 93.8%. for the diagnosis of EV. Conclusions In patients with HCV-related cirrhosis, the platelet count/spleen diameter may be proposed as a non-invasive tool for EV diagnosis, especially in financially deprived developing countries.