Performance of Platelet Count/Spleen Diameter Ratio for Diagnosis of Esophageal Varices in Cirrhosis: A Meta-Analysis
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Platelet count/spleen diameter ratio (PSR) is a non-invasive method for the assessment of esophageal varices (EV), developed as an alternative to endoscopy.
To assess the performance of PSR for diagnosis of EV using meta-analysis.
PubMed, EMBASE, the Cochrane Library, ISI web of Knowledge, China National Knowledge Infrastructure, and article references were searched. We included studies using endoscopy as a reference standard, with the data necessary to calculate the true and false positive, true and false negative diagnostic results of PSR for EV. The quality of the studies was rated with the QUADAS tool. The hierarchical summary receiver operating characteristic (HSROC) was used to examine the PSR accuracy for the diagnosis of EV. Heterogeneity was explored using meta-regression. Clinical utility of PSR for EV was evaluated by a Fagan plot.
In 20 studies (n = 3,063), the HSROC of the PSR for EV was 0.95 at various thresholds. At the threshold of 909, the summary sensitivities and specificities were 0.92 (95% CI, 0.79–0.97) and 0.87 (95% CI, 0.76–0.93), respectively. The HSROC was also 0.95 at the threshold of 909. If PSR was below 909 for EV (“positive” result), the post-test probability (if pre-test probability was 50%) was 87%, while if PSR was at or over 909 (“negative” result), the post-test probability was only 9%. PSR also had a high accuracy in diagnosis of EV in patients with compensated cirrhosis.
PSR can identify EV in cirrhosis with a high accuracy. Application of this index may decrease the need for endoscopy among cirrhotic patients.
- Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology. 2007;46:922–938. CrossRef
- Garcia-Tsao G, Bosch J. Management of varices and variceal hemorrhage in cirrhosis. N Engl J Med. 2010;362:823–832. CrossRef
- de Franchis R. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2010;53:762–768. CrossRef
- Eisen GM, Baron TH, Dominitz JA, et al. Complications of upper GI endoscopy. Gastrointest Endosc. 2002;55:784–793. CrossRef
- Merli M, Nicolini G, Angeloni S, et al. Incidence and natural history of small esophageal varices in cirrhotic patients. J Hepatol. 2003;38:266–272. CrossRef
- Kim BK, Han KH, Park JY, et al. A liver stiffness measurement-based, noninvasive prediction model for high-risk esophageal varices in B-viral liver cirrhosis. Am J Gastroenterol. 2010;105:1382–1390. CrossRef
- Sebastiani G, Tempesta D, Fattovich G, et al. Prediction of oesophageal varices in hepatic cirrhosis by simple serum non-invasive markers: results of a multicenter, large-scale study. J Hepatol. 2010;53:630–638. CrossRef
- Tarantino G, Citro V, Esposito P, et al. Blood ammonia levels in liver cirrhosis: a clue for the presence of portosystemic collateral veins. BMC Gastroenterol. 2009;9:21. CrossRef
- Giannini E, Botta F, Borro P, et al. Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis. Gut. 2003;52:1200–1205. CrossRef
- Giannini EG, Zaman A, Kreil A, et al. Platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices: results of a multicenter, prospective, validation study. Am J Gastroenterol. 2006;101:2511–2519. CrossRef
- Camma C, Petta S, Di Marco V, et al. Insulin resistance is a risk factor for esophageal varices in hepatitis C virus cirrhosis. Hepatology. 2009;49:195–203. CrossRef
- Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol. 2003;3:25. CrossRef
- Doust JA, Glasziou PP, Pietrzak E, Dobson AJ. A systematic review of the diagnostic accuracy of natriuretic peptides for heart failure. Arch Intern Med. 2004;164:1978–1984. CrossRef
- Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–560. CrossRef
- Deeks JJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol. 2005;58:882–893. CrossRef
- Hellmich M, Lehmacher W. A ruler for interpreting diagnostic test results. Methods Inf Med. 2005;44:124–126.
- Legasto GM, Sevilla J, Balay A, et al. Platelet count/spleen diameter ratio: a noninvasive parameter to predict the presence of esophageal varices. Phillippine J Gastroenterol. 2006;2:33–38.
- Agha A, Anwar E, Bashir K, Savarino V, Giannini EG. External validation of the platelet count/spleen diameter ratio for the diagnosis of esophageal varices in hepatitis C virus-related cirrhosis. Dig Dis Sci. 2009;54:654–660. CrossRef
- Makarem MA, Shatat ME, Shaker Y, et al. Platelet count/bipolar spleen diameter ratio for the prediction of esophageal varices: the special Egyptian situation. Hepatitis Monthly. 2011;11:278–284.
- Baig WW, Nagaraja MV, Varma M, Prabhu R. Platelet count to spleen diameter ratio for the diagnosis of esophageal varices: is it feasible? Can J Gastroenterol. 2008;22:825–828.
- Barikbin R, Hekmatnia A, Omidifar N, Farghadani M, Adibi P. Prediction severity of esophageal varices: a new cutoff point for platelet count/spleen diameter ratio. Minerva Gastroenterol Dietol. 2010;56:1–6.
- Cherian JV, Deepak N, Ponnusamy RP, Somasundaram A, Jayanthi V. Non-invasive predictors of esophageal varices. Saudi J Gastroenterol. 2011;17:64–68. CrossRef
- Lei JB, Huang TZ. Value of the platelet count/spleen diameter ratio on predicting esophageal varices of liver cirrhosis [In Chinese]. Pract Clin Med. 2007;8:25–27.
- Stefanescu H, Grigorescu M, Lupsor M, Procopet B, Maniu A, Badea R. Spleen stiffness measurement using Fibroscan for the noninvasive assessment of esophageal varices in liver cirrhosis patients. J Gastroenterol Hepatol. 2011;26:164–170. CrossRef
- Yu JY, Liu XN, Wang D, Cui JJ. Non-invasive predictive factors of esophageal varices in patients with post-hepatitis B cirrhosis [In Chinese]. J Binzhou Medical University. 2008;31.
- Barrera F, Riquelme A, Soza A, et al. Platelet count/spleen diameter ratio for non-invasive prediction of high risk esophageal varices in cirrhotic patients. Ann Hepatol. 2009;8:325–330.
- Mattos AZ, Mattos AA, Vianna FF, Musskopf MI, Pereira-Lima JC, Maciel AC. Platelet count/spleen diameter ratio: analysis of its capacity as a predictor of the existence of esophageal varices. Arq Gastroenterol. 2010;47:275–278. CrossRef
- Sethar GH, Ahmed R, Rathi SK, Shaikh NA. Platelet count/splenic size ratio: a parameter to predict the presence of esophageal varices in cirrhotics. J Coll Physicians Surg Pak. 2006;16:183–186.
- Tao W, Yang SQ, Lv XC, Yang L. Value of the platelet count/spleen diameter ratio on diagnosis of esophageal varices in patients with cirrhosis [In Chinese]. J Ningxia Med Coll. 2008;30:349–350.
- Nashaat EH, Abd-Elaziz H, Sabry M, Ibrahim AA. Non-endoscopic predictors of esophageal varices and portal hypertensive gastropathy. Nature Sci. 2010;8:43–50.
- Schwarzenberger E, Meyer T, Golla V, Sahdala NP, Min AD. Utilization of platelet count spleen diameter ratio in predicting the presence of esophageal varices in patients with cirrhosis. J Clin Gastroenterol. 2010;44:146–150. CrossRef
- Esmat S, Omran D. Study of the right liver lobe size/albumin ratio as a noninvasive predictor of oesophageal varices compared to: spleen size, platelet count and platelet count/spleen diameter ratio in post hepatitis C virus liver cirrhosis in Egypt. J American Sci. 2011;7:962–968.
- de Franchis R. Non-invasive (and minimally invasive) diagnosis of oesophageal varices. J Hepatol. 2008;49:520–527. CrossRef
- Performance of Platelet Count/Spleen Diameter Ratio for Diagnosis of Esophageal Varices in Cirrhosis: A Meta-Analysis
Digestive Diseases and Sciences
Volume 57, Issue 6 , pp 1672-1681
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Diagnostic accuracy
- Noninvasive markers
- Industry Sectors
- Author Affiliations
- 1. Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, 325000, China
- 2. Department of Infection and Liver Diseases, Institution of Hepatology, The First Affiliated Hospital of Wenzhou Medical College, No. 2 Fuxue lane, Wenzhou, 325000, China