Platelet Count/Splenic Diameter Ratio as a Non-Invasive Predictor of Esophageal Varices in Cirrhosis: An Observational Study

Abstract

Background: Esophageal varices are a major complication of portal hypertension in cirrhosis, and endoscopic screening, though the diagnostic standard, is invasive and resource-intensive. The platelet count/splenic diameter (PC/SD) ratio has been proposed as a simple non-invasive predictor of esophageal varices. This study evaluated the diagnostic performance of the PC/SD ratio in patients with cirrhosis attending a tertiary care center. Materials and Methods: This cross-sectional observational study included 380 patients with cirrhosis undergoing screening upper gastrointestinal endoscopy. Platelet count and splenic diameter (by ultrasonography) were recorded for each patient, and the PC/SD ratio was calculated and correlated with endoscopic findings. Results: Esophageal varices were present in 261 (68.7%) patients. The mean PC/SD ratio was significantly lower in patients with varices than in those without (5.4 ± 2.7 vs. 10.9 ± 3.9; P < 0.001) but did not differ meaningfully between variceal grades. At a cut-off of ≤8.3, the PC/SD ratio predicted esophageal varices with 90.4% sensitivity, 89.1% specificity, and an area under the receiver operating characteristic curve of 0.868. The ratio correlated strongly with platelet count (ρ = +0.916) and splenic diameter (ρ = −0.723) and performed consistently across genders and etiologies of cirrhosis. Conclusion: The PC/SD ratio is a simple, inexpensive, and reliable non-invasive marker for predicting the presence of esophageal varices in cirrhosis and may help triage patients for screening endoscopy, particularly in resource-limited settings.