CIRRHOSIS: NON-INVASIVE PARAMETERS FOR PREDICTING THE OCCURRENCE OF OOESOPHAGEAL VARICES

BACKGROUND Cirrhosis of liver results in portal venous hypertension and ooesophageal varices when decompensated. The present study aims to study the non-invasive clinical, biochemical and ultrasonographic parameters to predict the risk of ooesophageal varices to correlate platelet count/splenic diameter ratio with grade of varices and to study the type of anaemia picture in cirrhotics. MATERIALS AND METHODS 50 patients (25 female, 25 male) of cirrhosis between 20-60 years of age, presenting to the Medicine Department OPD/Ward, Stanley Hospital, Chennai, during March-August 2013, diagnosed by ultrasonography and biochemical parameters were investigated, classified under Child Pugh's and results analysed in SPSS 14 version for statistics. RESULTS AND OBSERVATION Out of 50 patients 26, 46, 28 were the respective percentages in Child Pugh's A, B, C. The mean platelet count in cirrhotics with no, small, large ooesophageal varices were 153.64, 132.94 and 90.27 respectively. Platelet count can predict ooesophageal varices with a sensitivity of 74.36%, specificity of 72.73% with a mean of 132.9 x 1000/cmm. The mean portal vein diameter in cirrhotics with no, small, large ooesophageal varices were 12.9, 14.24 and 15.80 mm respectively. It alone can predict varices with 69.23% sensitivity and 81.8% specificity with a mean of 14.23 mm. The mean splenic diameter in cirrhotics were 141.80, 143.70 and 178.18 mm in no, small and large varices respectively. It alone predicts varices with 74.35% sensitivity and 65.63% specificity with a mean of 143.7 mm. The platelet count/splenic diameter ratio were 1.09, 0.94, 0.52 respectively in cirrhotics with no, small, large varices. It predicts varices with 79.5% sensitivity and 91.18% specificity with a mean of 0.93.22; out of 50, 44% had dimorphic, 24% had microcytic hypochromic, 22% haemolytic, 4% had pancytopenia, 4% had thrombocytopenia and 2% had normal blood picture in peripheral smear. CONCLUSION Study predicts the large ooesophageal varices with 100% specificity and 100% positive predictive value. Hence, non-invasive parameters can predict the presence of varices in cirrhotics.