Correlation of platelet/spleen index as a predictive factor for esophageal varices in patients with liver cirrhosis
Keywords:
liver cirrhosis, esophageal and gastric varices, platelets, spleen, splenomegaly
Abstract
Introduction: Liver cirrhosis is the most common cause of blood flow obstruction in the portal venous system. Variceal bleeding is a complication of cirrhosis that defines its decompensation.
Objective: To establish the correlation between the platelet/spleen index as a predictive factor for esophageal varices in patients with liver cirrhosis treated at the Luis Vernaza Hospital between January 2022 and December 2023.
Methodology: A retrospective case analysis design was applied. Population: 108 cases of adults with liver cirrhosis were included, with platelet analysis samples and abdominal ultrasound with spleen measurement. Data analysis: To determine whether the platelet/spleen ratio is a predictor of esophageal varices in cirrhotic patients, univariate and bivariate analyses were performed between the variables, yielding predictive power through logistic regression, with established statistical significance (p < 0.05).
Results: The cutoff point of the platelet/spleen index for predictive value was <909, with a p-value of 0.003, indicating a 3.78 times higher probability of presenting esophageal varices, which in turn increases the hospital stay. The average age was 64 years, with an equal distribution of sexes (50.93% women and 49.07% men), and the most common comorbidity was diabetes mellitus (33.64%). The Child-Pugh C scale was associated with a higher presence of esophageal varices.
Conclusions: The platelet/spleen index with a cutoff point of <909 predicts the presence of esophageal varices and prolongs hospital stay.
References
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7. Alqahtani SA, Jang S. Pathophysiology and management of variceal bleeding. Drugs. 2021;81(6):647–67.
8. Sanyal AJ, Garcia-Pagán JC. Primary prevention of bleeding from esophageal varices in patients with cirrhosis. UpToDate [Internet]. 2025 [cited 2025 Jul 31]. Available from: https://www.uptodate.com/contents/primary-prevention-of-bleeding-from-esophageal-varices-in-patients-with-cirrhosis?search=varices%20esofagicas&source=search_result&selectedTitle=1~136&usage_type=default&display_rank=1
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16. Sajja KC, Mohan DP, Rockey DC. Age and ethnicity in cirrhosis. J Investig Med [Internet]. 2014 [cited 2024 Feb 8];62(7):920–6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172494/
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21. Mazumder NR, Celaj S, Atiemo K, Daud A, Jackson KL, Kho A, et al. Liver-related mortality is similar among men and women with cirrhosis. J Hepatol [Internet]. 2020 [cited 2024 Feb 8];73(5):1072–81. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572539/
22. Amir Sherazi SA, Goyal H, Tahir H, Achebe I, Warraich MS, Demetria M. Gender differences in cirrhosis: Analysis of demographics, outcomes and healthcare utilization from a national database. [Abstracts: S1218]. Am J Gastroenterol [Internet]. 2021 [cited 2024 Feb 8];116:S562. Available from: https://journals.lww.com/ajg/fulltext/2021/10001/s1218_gender_differences_in_cirrhosis__analysis_of.1219.aspx
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24. Vaz J, Eriksson B, Strömberg U, Buchebner D, Midlöv P. Incidence, aetiology and related comorbidities of cirrhosis: a Swedish population-based cohort study. BMC Gastroenterol [Internet]. 2020 [cited 2024 Feb 8];20(1):84. Available from: https://pubmed.ncbi.nlm.nih.gov/32245414/
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28. Dumont C, Wuestenberghs F, Lanthier N, Piessevaux H, Dahlqvist G. Malnutrition is highly prevalent in hospitalized cirrhotic patients and associates with a poor outcome. Acta Gastroenterol Belg [Internet]. 2022 [cited 2024 Feb 8];85(2):311–9. Available from: https://pubmed.ncbi.nlm.nih.gov/35709775/
29. Hansen L, Chang MF, Hiatt S, Dieckmann NF, Mitra A, Lyons KS, Lee ChS. Symptom classes in decompensated liver disease. Clin Gastroenterol Hepatol [Internet]. 2022 [cited 2024 Feb 8];20(11):2551-7.e1. Available from: https://www.cghjournal.org/article/S1542-3565(21)01261-1/fulltext
30. Hansen L, Chang MF, Hiatt S, Dieckmann NF, Lyons KS, Lee ChS. Symptom frequency and distress underestimated in decompensated cirrhosis. Dig Dis Sci [Internet]. 2022 [cited 2024 Feb 8];67(8):4234–42. Available from: https://pubmed.ncbi.nlm.nih.gov/34448980/
31. Jamil Z, Durrani AA. Assessing the outcome of patients with liver cirrhosis during hospital stay: A comparison of lymphocyte/monocyte ratio with MELD and Child-Pugh scores. Turk J Gastroenterol [Internet]. 2018 May[cited 2024 Feb 8];29(3):308-315. doi: 10.5152/tjg.2018.17631. Available from: https://pubmed.ncbi.nlm.nih.gov/29755015/
32. Lim N, Desarno MJ, Lidofsky SD, Ganguly E. Hospitalization for variceal hemorrhage in an era with more prevalent cirrhosis. World J Gastroenterol [Internet]. 2014 [cited 2024 Feb 8];20(32):11326–32. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145772/
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34. Altamirano J, Zapata L, Augustin S, Muntaner L, González-Angulo A, Ortiz AL, et al. Predicting 6-week mortality after acute variceal bleeding: role of classification and regression tree analysis. Ann Hepatol [Internet]. 2009;8(4):308–15. Available from: https://pubmed.ncbi.nlm.nih.gov/20009129/
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2. Jakab SS, Garcia-Tsao G. Screening and surveillance of varices in patients with cirrhosis. Clin Gastroenterol Hepatol [Internet]. 2019 [cited 2023 Sept 9];17(1):26–9. Available from: https://pubmed.ncbi.nlm.nih.gov/29551741/
3. Ramírez-Del Pilar R, Yáñez-Montes MC, Enríquez-Peregrino KG, García-Arias MR, Hernández-Mendiola R, López-González DS, et al. Correlación del índice plaqueta/ bazo con el grado de várices esofágicas. Med interna Méx [Internet]. 2017 [citado 11 Ago 2023];33(3):344–50. Disponible en: https://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0186-48662017000300344&lng=es&nrm=iso&tlng=es
4. García Galicia A, Gámez Herrera A, González Bravo EI, Parker Bosquez RA, Montiel Jarquín ÁJ, León Zamudio JA, et al. Cociente plaquetas/bazo para el diagnóstico de várices esofágicas y riesgo de sangrado en pacientes con insuficiencia hepática. Rev Fac Med Hum [Internet]. 2021 [citado 11 Ago 2023];21(2):269–74. Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S2308-05312021000200269&lng=es&nrm=iso&tlng=es
5. Iredale JP, Med Sci F, Pellicoro A. Liver fibrosis: Therapeutic armory 40 Clin Liver Dis (Hoboken) [Internet]. 2015 [cited 2023 Ago 25]; 6(1): 1-4. Available from: https://pubmed.ncbi.nlm.nih.gov/31040974/
6. Parola M, Pinzani M. Liver fibrosis: Pathophysiology, pathogenetic targets and clinical issues. Mol Aspects Med [Internet]. 2019 [cited 2023 Ago 25]; 65:37–55. Available from: https://pubmed.ncbi.nlm.nih.gov/30213667/ Subscription required
7. Alqahtani SA, Jang S. Pathophysiology and management of variceal bleeding. Drugs. 2021;81(6):647–67.
8. Sanyal AJ, Garcia-Pagán JC. Primary prevention of bleeding from esophageal varices in patients with cirrhosis. UpToDate [Internet]. 2025 [cited 2025 Jul 31]. Available from: https://www.uptodate.com/contents/primary-prevention-of-bleeding-from-esophageal-varices-in-patients-with-cirrhosis?search=varices%20esofagicas&source=search_result&selectedTitle=1~136&usage_type=default&display_rank=1
9. Martínez-Marín JD, Marrugo-Padilla K, Garzón-Olarte MA. Diagnostic performance of platelet count/spleen diameter ratio to detect esophageal varices in patients with cirrhosis. Rev Fac Med [Internet]. 2021 [cited 2023 Ago 11];69(3):e78786. Available from: https://revistas.unal.edu.co/index.php/revfacmed/article/view/78786/81518
10. Gunda DW, Kilonzo SB, Mamballah Z, Manyiri PM, Majinge DC, Jaka H, et al. The magnitude and correlates of esophageal varices among newly diagnosed cirrhotic patients undergoing screening fibre optic endoscope before incident bleeding in North-Western Tanzania; a cross-sectional study. BMC Gastroenterol [Internet]. 2019 [cited 2024 Feb 8];19(1):203. Available from: https://pubmed.ncbi.nlm.nih.gov/31783802/
11. Duah A, Nkrumah KN, Tachi K. Oesophageal varices in patients with liver cirrhosis attending a major tertiary hospital in Ghana. Pan Afr Med J [Internet]. 2018 [cited 2024 Feb 8]; 31:230. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6691363/
12. Elghezewi A, Hammad M, El-Dallal M, Mohamed M, Sherif A, Frandah W. Trends in hospitalizations of esophageal varices from 2011 to 2018: A United States nationwide study. Gastroenterology Res [Internet]. 2023 [cited 2024 Feb 8];16(3):171–83. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10284649/
13. Caiza Poaquiza FM, Galárraga Pérez EA. Prevalencia de la cirrosis hepática en pacientes alcohólicos en Ecuador. Revista Científica Arbitrada Multidisciplinaria PENTACIENCIAS [Internet]. 2023 [citado 8 Feb 2024];5(4):661–72. Disponible en: https://www.editorialalema.org/index.php/pentaciencias/article/view/708
14. Bhusal M, Pathak R, Bhandari BK, Jha A, Hamal R, Koirala D, et al. Liver cirrhosis among young adults admitted to the Department of Gastroenterology in a Tertiary Care Centre: A descriptive cross-sectional study. JNMA J Nepal Med Assoc [Internet]. 2023 [cited 2024 Feb 8];61(258):115–8. Available from: https://pubmed.ncbi.nlm.nih.gov/37203980/
15. Stahl EC, Haschak MJ, Popovic B, Brown BN. Macrophages in the aging liver and age-related liver disease. Front Immunol [Internet]. 2018 [cited 2024 Feb 8];9: 2795. Available from: https://pubmed.ncbi.nlm.nih.gov/30555477/
16. Sajja KC, Mohan DP, Rockey DC. Age and ethnicity in cirrhosis. J Investig Med [Internet]. 2014 [cited 2024 Feb 8];62(7):920–6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172494/
17. Guevara Benavides SA, Lincango Gualoto FA. Caracterización clínico-epidemiológica de la cirrosis hepática descompensada. Hospital Carlos Andrade Marín. Quito 2022 [Internet] [Tesis]. Riobamba: Universidad Nacional de Chimborazo, Facultad de Ciencias de la Salud, Carrera de Medicina; 2023 [citado 8 Feb 2024]. Disponible en: http://dspace.unach.edu.ec/handle/51000/10513
18. UPMC HealthBeat. Are men more susceptible to liver disease? [Internet]. Pittsburgh: University of Pittsburgh Medical Center; 2024] [cited 2024 Nov 4]. Available from: https://share.upmc.com/2023/01/gender-and-liver-disease/
19. Roerecke M, Vafaei A, Hasan OSM, Chrystoja BR, Cruz M, Lee R, et al. Alcohol consumption and risk of liver cirrhosis: a systematic review and meta-analysis. Am J Gastroenterol [Internet]. 2019 [cited 2024 Feb 8];114(10):1574–86. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6776700/
20. Rubin JB, Sundaram V, Lai JC. Gender differences among patients hospitalized with cirrhosis in the United States. J Clin Gastroenterol [Internet]. 2020 [cited 2024 Feb 8];54(1):83–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6706332/
21. Mazumder NR, Celaj S, Atiemo K, Daud A, Jackson KL, Kho A, et al. Liver-related mortality is similar among men and women with cirrhosis. J Hepatol [Internet]. 2020 [cited 2024 Feb 8];73(5):1072–81. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572539/
22. Amir Sherazi SA, Goyal H, Tahir H, Achebe I, Warraich MS, Demetria M. Gender differences in cirrhosis: Analysis of demographics, outcomes and healthcare utilization from a national database. [Abstracts: S1218]. Am J Gastroenterol [Internet]. 2021 [cited 2024 Feb 8];116:S562. Available from: https://journals.lww.com/ajg/fulltext/2021/10001/s1218_gender_differences_in_cirrhosis__analysis_of.1219.aspx
23. Jepsen P. Comorbidity in cirrhosis. World J Gastroenterol [Internet]. 2014 [cited 2024 Feb 8];20(23):7223–30. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064068/
24. Vaz J, Eriksson B, Strömberg U, Buchebner D, Midlöv P. Incidence, aetiology and related comorbidities of cirrhosis: a Swedish population-based cohort study. BMC Gastroenterol [Internet]. 2020 [cited 2024 Feb 8];20(1):84. Available from: https://pubmed.ncbi.nlm.nih.gov/32245414/
25. Mukthinuthalapati PKVV, Syed M, Salazar M, Akinyeye S, Fricker Z, Ghabril M, et al. Prevalence of comorbidities in patients with cirrhosis admitted to U.S. Safety Net Hospitals and their impact on clinical phenotype of admission Abstracts: S1007]. Am J Gastroenterol [Internet]. 2018 [cited 2024 Feb 8];113: S566-7. Available from: https://journals.lww.com/ajg/fulltext/2018/10001/prevalence_of_comorbidities_in_patients_with.1007.aspx
26. Pincay Castro RW. Prevalencia del sobrepeso y la obesidad en pacientes con cirrosis hepática, del servicio de gastroenterología del Hospital General Monte Sinaí, en el 2022 [Tesis] [Internet]. Guayaquil: Universidad de las Américas, 2023. [citado 8 Feb 2024]. Disponible en: http://dspace.udla.edu.ec/handle/33000/14720
27. Perdomo Puentes JC, Rocha H, Nicolau S, Ferrão G. Effectiveness of the MELD/Na score and the Child–Pugh score for the identification of palliative care needs in patients with cirrhosis of the liver. Indian J Palliat Care [Internet]. 2018 [cited 2024 Feb 8];24(4):526–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6199842/
28. Dumont C, Wuestenberghs F, Lanthier N, Piessevaux H, Dahlqvist G. Malnutrition is highly prevalent in hospitalized cirrhotic patients and associates with a poor outcome. Acta Gastroenterol Belg [Internet]. 2022 [cited 2024 Feb 8];85(2):311–9. Available from: https://pubmed.ncbi.nlm.nih.gov/35709775/
29. Hansen L, Chang MF, Hiatt S, Dieckmann NF, Mitra A, Lyons KS, Lee ChS. Symptom classes in decompensated liver disease. Clin Gastroenterol Hepatol [Internet]. 2022 [cited 2024 Feb 8];20(11):2551-7.e1. Available from: https://www.cghjournal.org/article/S1542-3565(21)01261-1/fulltext
30. Hansen L, Chang MF, Hiatt S, Dieckmann NF, Lyons KS, Lee ChS. Symptom frequency and distress underestimated in decompensated cirrhosis. Dig Dis Sci [Internet]. 2022 [cited 2024 Feb 8];67(8):4234–42. Available from: https://pubmed.ncbi.nlm.nih.gov/34448980/
31. Jamil Z, Durrani AA. Assessing the outcome of patients with liver cirrhosis during hospital stay: A comparison of lymphocyte/monocyte ratio with MELD and Child-Pugh scores. Turk J Gastroenterol [Internet]. 2018 May[cited 2024 Feb 8];29(3):308-315. doi: 10.5152/tjg.2018.17631. Available from: https://pubmed.ncbi.nlm.nih.gov/29755015/
32. Lim N, Desarno MJ, Lidofsky SD, Ganguly E. Hospitalization for variceal hemorrhage in an era with more prevalent cirrhosis. World J Gastroenterol [Internet]. 2014 [cited 2024 Feb 8];20(32):11326–32. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145772/
33. Solanki S, Haq KF, Chakinala RCh, Khan Z, Aronow WS, Khan MA, et al. Inpatient burden of esophageal varices in the United States: analysis of trends in demographics, cost of care, and outcomes. Ann Transl Med [Internet]. 2019 [cited 2024 Feb 8];7(18):480. Available from: https://pubmed.ncbi.nlm.nih.gov/31700916/
34. Altamirano J, Zapata L, Augustin S, Muntaner L, González-Angulo A, Ortiz AL, et al. Predicting 6-week mortality after acute variceal bleeding: role of classification and regression tree analysis. Ann Hepatol [Internet]. 2009;8(4):308–15. Available from: https://pubmed.ncbi.nlm.nih.gov/20009129/
35. Tiwari PS, Thapa P, Karki B, Sudhamshu KC. Correlation of Child-Pugh classification with esophageal varices in patients with liver cirrhosis. J Nepalgunj Med College [Internet]. 2022 [cited 2024 Feb 8];20(1):4–8. Available from: https://www.nepjol.info/index.php/JNGMC/article/view/48105
36. Thapa PB, Maharjan DK, Tamang TY, Shrestha SK. Clinical correlation between Child Pugh’s score and oesophageal varices in upper gastrointestinal endoscopy in cirrhotic patient. J Kathmandu Med Coll [Internet]. 2015 [cited 2024 Feb 8];4(4):135–9. Available from: https://www.nepjol.info/index.php/JKMC/article/view/18255
37. Gomaa AAH, Mohammed SF, Mousa WM, Hasan NFE, Mhdy MAM. Evaluation of ALBI, MELD and Child-Pugh scores as non-invasive predictors of esophageal varices. Egypt J Hosp Med [Internet]. 2018 [cited 2024 Feb 8];73(8):7358–64. Available from: https://ejhm.journals.ekb.eg/article_18469.html
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Published
2025-08-21
Issue
Section
ARTICULOS ORIGINALES
