Study the association between platelets count and grades of oesophageal varies in patients of cirrhosis of liver with portal hypertension
DOI:
https://doi.org/10.18203/2349-3933.ijam20201108Keywords:
Cirrhosis of liver, Gastro-oesophageal varices, Platelets count, Portal hypertensionAbstract
Background: cirrhosis of liver is a diffuse process of fibrosis that converts the liver architecture into structurally abnormal nodules Portal hypertension leads to dilatation of portal vein, splenomegaly, and formation of portal systemic collaterals at different sites. Screening endoscopy is recommended for early detection of esophageal varices (EVs) in cirrhotic patients with portal hypertension. However, this approach is limited by its invasiveness and cost. The aim of the study was to determine if platelet count can predict the presence of EVs, especially large (grade III, IV) EVs in need of prophylactic therapy.
Methods: Statistically 100 patients previously or newly diagnosed with cirrhosis of liver with portal hypertension without history of hepatic encephalopathy, variceal bleeding, EVL, use of beta blockers, were selected for the study. Ultrasonography was performed in all cases to note the spleen size. Routine blood testing including platelet count was done and UGI-Endoscopy was done to detect presence of varices with grades. Statistical Analysis: Statistical analysis was done using Statistical Package for Social Survey (SPSS) for Windows version 17.0. The data obtained was analysed using mean, SD, Student’s t-test and chi square correlation coefficient, p value <0.05 was considered significant.
Results: Among 100 patients studied ,90% patients were found to have esophageal varices. Based on endoscopic grading, incidence of grade 2 and grade 3 esophageal varices predominated, accounting to 48% and 23 % respectively. On correlation of platelet count with grades of esophageal varices it was evident that 44 patients had their platelet count less than 1 lac out of which 24 patients had grade 2 varices followed by 14 patients with grade 3 varices, p value <0.001 and was highly significant.
Conclusions: The study depicts that with decrease in platelets count the chances of formation of higher grades of oesophageal varices increases and also a positive association exists.
References
Bosch J, García-Pagán JC. Complications of cirrhosis. I. Portal hypertension. J Hepatol. 2000;32:141-56.
Bhathal PS, Grossman HJ. Reduction of the increased portal vascular resistance of the isolated perfused cirrhotic rat liver by vasodilators. J Hepatol. 1985 Jan 1;1(4):325-37.
Garcia‐Tsao G, Sanyal AJ, Grace ND, Carey W, Practice Guidelines Committee of the American Association for the Study of Liver Diseases, the Practice Parameters Committee of the American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatol. 2007 Sep;46(3):922-38.
Grgurević I, Jukić I, Sokol S. low specificity of platelet to spleen ratio for noninvasive prediction and characterization of esophageal varices in patients with alcoholic liver cirrhosis. Acta Med Croatica. 2014;68:353-60.
Chiodi D, Hernández N, Saona G, Sánchez A, Berrueta J, Mescia G, et al. Noninvasive diagnosis of esophageal varicose veins in cirrhotic patients. Latin Am Gastroenterol Act. 2014;44(2):108-13.
Afdhal N, McHutchison J, Brown R, Jacobson I, Manns M, Poordad F, et al. Thrombocytopenia associated with chronic liver disease. J Hepatol. 2008 Jun 1;48(6):1000-7.
Hayashi H, Beppu T, Shirabe K, Maehara Y, Baba H. Management of thrombocytopenia due to liver cirrhosis: a review. World J Gastroenterol: WJG. 2014 Mar 14;20(10):2595-605.
Sarangapani A, Shanmugam C, Kalyanasundaram M, Rangachari B, Thangavelu P, Subbarayan JK. Noninvasive prediction of large esophageal varices in chronic liver disease patients. Saudi J Gastroenterol: Official J Saudi Gastroenterol Assoc. 2010 Jan;16(1):38-42.
Rye K, Scott R, Mortimore G, Lawson A, Austin A, Freeman J. Towards non-invasive detection of oesophageal varices. Int J Hepatol. 2012;2012:343-91.
De Franchis R, Dell’Era A, Primignani M. Diagnosis and monitoring of portal hypertension. Dig Liver Dis. 2008;40:312-7.
Garcia-Tsao G, Escorsell A, Zakko M. Predicting the presence of significant portal hypertension and varices in compensated cirrhotic patients. Hepatol. 1997;26:360A.
D’ Amico G, Morabito A. Noninvasive markers of esophageal varices: another round, not the last. Hepatol. 2004;39:30-4.
Baig WW, Nagaraja MV, Varma M, Prabhu R. "Platelet count to spleen diameter ratio for the diagnosis of oesophageal varices: Is it feasible? Can J Gastroenterol. 2008;22(10):825-8.
Cherian JV, Deepak N, Ponnusamy RP, Somasundaram A, Jayanthi V. Non-invasive predictors of esophageal varices. Saudi J Gastroenterol. 2011;17:64-8.
Mandal L, Mandal SK, Bandyopadhyay D, Datta S. Correlation of portal vein diameter and splenic size with gastro-oesophageal varices in cirrhosis of liver. J Ind Aca Clin Med. 2011 Oct;12(4):266-70.
Garcia-T, Sao G, Groszmann RJ, Fisher RL. Portal pressure, presence of Gastro-oesophageal varices and variceal bleeding. Hepatol. 1975;5:419-24.
Pilette C, Oberti F, Aubé C. Non-invasive diagnosis of esophageal varices in chronic liver disease. J Hepatol. 1999;31:867-73.
Thomopoulos KC, Labropoulou-Karatza C, Mimidis KP, Katsakoulis EC, Iconomou G, Nikolopoulou VN. Non-invasive predictors of the presence of large esophageal varices in patients with cirrhosis. Digest Liver Dis. 2003;35(7):473-78.
Chalasani N, Imperiale TF, Ismail A. Predictors of large esophageal varices in patients with cirrhosis. Am J Gastroenterol. 1999;94:3285-91.
Schepis F, Cammà C, Niceforo D, Magnano A, Pallio S, Cinquegrani M, et al. Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection? Hepatol. 2001 Feb;33(2):333-8.
Zaman A, Hapke R, Flora K, Rosen HR, Benner K. Factors predicting the presence of esophageal or gastric varices in patients with advanced liver disease. Am J Gastroenterol. 1999 Nov 1;94(11):3292-6.
Abbasi A, Butt N, Bhutto AR. Correlation of thrombocytopenia with grading of esophageal varices in chronic liver disease patients. J Coll Phys Surg Pakistan. 2010;20:369-72.
