Platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices: Results of a multicenter, prospective, validation study

Edoardo G. Giannini, Atif Zaman, Anna Kreil, Annarosa Floreani, Pietro Dulbecco, Emanuela Testa, Roya Sohaey, Peter Verhey, Markus Peck-Radosavljevic, Carlo Mansi, Vincenzo Savarino, Roberto Testa

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Abstract

BACKGROUND AND AIMS: Noninvasive assessment of esophageal varices (EV) may improve the management of patients with cirrhosis and decrease both the medical and financial burden related to screening. In this multicenter, international study, our aim was to prospectively validate the use of the platelet count/spleen diameter ratio for the noninvasive diagnosis of EV. METHODS: A total of 218 cirrhotic patients underwent screening endoscopy for EV. Platelet count/spleen diameter ratio ((N/mm 3)/mm) was assessed in all patients and its diagnostic accuracy was calculated. On the basis of previous results, a platelet count/spleen diameter ratio cutoff of 909 was applied to this population. The diagnostic accuracy of the platelet count/spleen diameter ratio was further evaluated for both severity and etiology of disease subgroups. RESULTS: Prevalence of EV was 54.1%. The platelet count/spleen diameter ratio had 86.0% (95% CI, 80.7-90.4%) diagnostic accuracy for EV, which was significantly greater as compared with either accuracy of platelet count alone (83.6%, 95% CI 78.0-88.3%, P = 0.038) or spleen diameter alone (80.2%, 95% CI 74.3-85.3%, P = 0.018). The 909 cutoff had 91.5% sensitivity (95% CI 85.0-95.9%), 67.0% specificity (95% CI 56.9-76.1%), 76.6% positive predictive value, 87.0% negative predictive value, 2.77 positive likelihood ratio, and 0.13 negative likelihood ratio for the diagnosis of EV. Accuracy of the platelet count/spleen diameter ratio was maintained for both severity and etiology of disease subgroups. CONCLUSIONS: The platelet count/spleen diameter ratio may be proposed as a safe and reproducible means to improve the management of cirrhotic patients who should undergo screening endoscopy for EV.

Original languageEnglish (US)
Pages (from-to)2511-2519
Number of pages9
JournalAmerican Journal of Gastroenterology
Volume101
Issue number11
DOIs
StatePublished - Nov 2006

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Esophageal and Gastric Varices
Validation Studies
Platelet Count
Spleen
Prospective Studies
Endoscopy
Fibrosis

ASJC Scopus subject areas

  • Gastroenterology

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Platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices : Results of a multicenter, prospective, validation study. / Giannini, Edoardo G.; Zaman, Atif; Kreil, Anna; Floreani, Annarosa; Dulbecco, Pietro; Testa, Emanuela; Sohaey, Roya; Verhey, Peter; Peck-Radosavljevic, Markus; Mansi, Carlo; Savarino, Vincenzo; Testa, Roberto.

In: American Journal of Gastroenterology, Vol. 101, No. 11, 11.2006, p. 2511-2519.

Research output: Contribution to journalArticle

Giannini, EG, Zaman, A, Kreil, A, Floreani, A, Dulbecco, P, Testa, E, Sohaey, R, Verhey, P, Peck-Radosavljevic, M, Mansi, C, Savarino, V & Testa, R 2006, 'Platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices: Results of a multicenter, prospective, validation study', American Journal of Gastroenterology, vol. 101, no. 11, pp. 2511-2519. https://doi.org/10.1111/j.1572-0241.2006.00874.x
Giannini, Edoardo G. ; Zaman, Atif ; Kreil, Anna ; Floreani, Annarosa ; Dulbecco, Pietro ; Testa, Emanuela ; Sohaey, Roya ; Verhey, Peter ; Peck-Radosavljevic, Markus ; Mansi, Carlo ; Savarino, Vincenzo ; Testa, Roberto. / Platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices : Results of a multicenter, prospective, validation study. In: American Journal of Gastroenterology. 2006 ; Vol. 101, No. 11. pp. 2511-2519.
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abstract = "BACKGROUND AND AIMS: Noninvasive assessment of esophageal varices (EV) may improve the management of patients with cirrhosis and decrease both the medical and financial burden related to screening. In this multicenter, international study, our aim was to prospectively validate the use of the platelet count/spleen diameter ratio for the noninvasive diagnosis of EV. METHODS: A total of 218 cirrhotic patients underwent screening endoscopy for EV. Platelet count/spleen diameter ratio ((N/mm 3)/mm) was assessed in all patients and its diagnostic accuracy was calculated. On the basis of previous results, a platelet count/spleen diameter ratio cutoff of 909 was applied to this population. The diagnostic accuracy of the platelet count/spleen diameter ratio was further evaluated for both severity and etiology of disease subgroups. RESULTS: Prevalence of EV was 54.1{\%}. The platelet count/spleen diameter ratio had 86.0{\%} (95{\%} CI, 80.7-90.4{\%}) diagnostic accuracy for EV, which was significantly greater as compared with either accuracy of platelet count alone (83.6{\%}, 95{\%} CI 78.0-88.3{\%}, P = 0.038) or spleen diameter alone (80.2{\%}, 95{\%} CI 74.3-85.3{\%}, P = 0.018). The 909 cutoff had 91.5{\%} sensitivity (95{\%} CI 85.0-95.9{\%}), 67.0{\%} specificity (95{\%} CI 56.9-76.1{\%}), 76.6{\%} positive predictive value, 87.0{\%} negative predictive value, 2.77 positive likelihood ratio, and 0.13 negative likelihood ratio for the diagnosis of EV. Accuracy of the platelet count/spleen diameter ratio was maintained for both severity and etiology of disease subgroups. CONCLUSIONS: The platelet count/spleen diameter ratio may be proposed as a safe and reproducible means to improve the management of cirrhotic patients who should undergo screening endoscopy for EV.",
author = "Giannini, {Edoardo G.} and Atif Zaman and Anna Kreil and Annarosa Floreani and Pietro Dulbecco and Emanuela Testa and Roya Sohaey and Peter Verhey and Markus Peck-Radosavljevic and Carlo Mansi and Vincenzo Savarino and Roberto Testa",
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T1 - Platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices

T2 - Results of a multicenter, prospective, validation study

AU - Giannini, Edoardo G.

AU - Zaman, Atif

AU - Kreil, Anna

AU - Floreani, Annarosa

AU - Dulbecco, Pietro

AU - Testa, Emanuela

AU - Sohaey, Roya

AU - Verhey, Peter

AU - Peck-Radosavljevic, Markus

AU - Mansi, Carlo

AU - Savarino, Vincenzo

AU - Testa, Roberto

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N2 - BACKGROUND AND AIMS: Noninvasive assessment of esophageal varices (EV) may improve the management of patients with cirrhosis and decrease both the medical and financial burden related to screening. In this multicenter, international study, our aim was to prospectively validate the use of the platelet count/spleen diameter ratio for the noninvasive diagnosis of EV. METHODS: A total of 218 cirrhotic patients underwent screening endoscopy for EV. Platelet count/spleen diameter ratio ((N/mm 3)/mm) was assessed in all patients and its diagnostic accuracy was calculated. On the basis of previous results, a platelet count/spleen diameter ratio cutoff of 909 was applied to this population. The diagnostic accuracy of the platelet count/spleen diameter ratio was further evaluated for both severity and etiology of disease subgroups. RESULTS: Prevalence of EV was 54.1%. The platelet count/spleen diameter ratio had 86.0% (95% CI, 80.7-90.4%) diagnostic accuracy for EV, which was significantly greater as compared with either accuracy of platelet count alone (83.6%, 95% CI 78.0-88.3%, P = 0.038) or spleen diameter alone (80.2%, 95% CI 74.3-85.3%, P = 0.018). The 909 cutoff had 91.5% sensitivity (95% CI 85.0-95.9%), 67.0% specificity (95% CI 56.9-76.1%), 76.6% positive predictive value, 87.0% negative predictive value, 2.77 positive likelihood ratio, and 0.13 negative likelihood ratio for the diagnosis of EV. Accuracy of the platelet count/spleen diameter ratio was maintained for both severity and etiology of disease subgroups. CONCLUSIONS: The platelet count/spleen diameter ratio may be proposed as a safe and reproducible means to improve the management of cirrhotic patients who should undergo screening endoscopy for EV.

AB - BACKGROUND AND AIMS: Noninvasive assessment of esophageal varices (EV) may improve the management of patients with cirrhosis and decrease both the medical and financial burden related to screening. In this multicenter, international study, our aim was to prospectively validate the use of the platelet count/spleen diameter ratio for the noninvasive diagnosis of EV. METHODS: A total of 218 cirrhotic patients underwent screening endoscopy for EV. Platelet count/spleen diameter ratio ((N/mm 3)/mm) was assessed in all patients and its diagnostic accuracy was calculated. On the basis of previous results, a platelet count/spleen diameter ratio cutoff of 909 was applied to this population. The diagnostic accuracy of the platelet count/spleen diameter ratio was further evaluated for both severity and etiology of disease subgroups. RESULTS: Prevalence of EV was 54.1%. The platelet count/spleen diameter ratio had 86.0% (95% CI, 80.7-90.4%) diagnostic accuracy for EV, which was significantly greater as compared with either accuracy of platelet count alone (83.6%, 95% CI 78.0-88.3%, P = 0.038) or spleen diameter alone (80.2%, 95% CI 74.3-85.3%, P = 0.018). The 909 cutoff had 91.5% sensitivity (95% CI 85.0-95.9%), 67.0% specificity (95% CI 56.9-76.1%), 76.6% positive predictive value, 87.0% negative predictive value, 2.77 positive likelihood ratio, and 0.13 negative likelihood ratio for the diagnosis of EV. Accuracy of the platelet count/spleen diameter ratio was maintained for both severity and etiology of disease subgroups. CONCLUSIONS: The platelet count/spleen diameter ratio may be proposed as a safe and reproducible means to improve the management of cirrhotic patients who should undergo screening endoscopy for EV.

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