The Association Between Platelet Counts and the Esophageal Varices among Patients with Cirrhosis in Pranangklao Hospital, Thailand
Keywords:
esophageal varices, cirrhosis, platelets, appropriate cut-off valuesAbstract
Background: The most common complication in patients with cirrhosis is the occurrence of esophageal varices which can be diagnosed by endoscopic methods. The possible use of Platelet count for the diagnosis of esophageal varices in liver cirrhosis patients has been proposed. Therefore, it would be of great importance to reveal the association between platelet counts and the incidence of esophageal varices in cirrhotic patients.
Objective: To study the association between platelet counts and esophageal varices among cirrhotic patients in the Pranangklao Hospital.
Methods: This retrospective study was conducted at Pranangklao Hospital between October 2021 and September 2022. The sample size was calculated from the proportional estimation formula as 233 cases. Clinical information and laboratory results were collected and analyzed using the Chi-square test, Fisher exact test, and one-way ANOVA, as applicable. Optimal platelet cut-off values and esophageal varices were checked for sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and area under the receiver operating characteristic curve (AUROC).
Results: Of the total 233 patients diagnosed with liver cirrhosis at Pranangklao Hospital, 166 patients had esophageal varices (71.24%); and were further divided into Grade I (57 cases), Grade II (32 cases) and Grade III (77 cases). The correlation analysis found that the occurrence of esophageal varices was significantly associated with platelet count (p<0.001). Patients with cirrhosis and platelets <150,000 /µL were found to be associated with esophageal varices. (sensitivity= 68.7%), specific (specificity= 64.2%), and with ROC area = 0.664 (95%CI = 0.596 – 0.732), likelihood ratio (+) = 1.92, likelihood ratio (-) = 0.488, positive predictive value = 82.6%, and negative predictive value = 45.3%.
Conclusion: The platelets <150,000 /µL in patients with cirrhosis and were found to be associated with esophageal varices. Therefore, it could be used as a predictor of the condition.
References
ศักรินทร์ จิรพงศธร. Stage and natural history of cirrhosis. กรุงเทพฯ : สมาคมโรคตับแห่งประเทศไทย; 2561.
Garcia-Tsao G, Friedman S, Iredale J, Pinzani M. Now there are many (stages) where before there was one: in search of a pathophysiological classification of cirrhosis. Hepatology 2010;51(4):1445-9.
Bataller R, Brenner DA. Liver fibrosis. J Clin Invest 2005;115(2):209-18.
Asrani SK, Kamath PS. Natural history of cirrhosis. Curr Gastroenterol Rep 2013;15(2):308.
D’Amico G, Pasta L, Morabito A, D’Amico M, Caltagirone M, Malizia G, et al. Competing risks and prognostic stages of cirrhosis: a 25-year inception cohort study of 494 patients. Aliment Pharmacol Ther 2014;39(10):1180-93.
Groszmann RJ, Garcia-Tsao G, Bosch J, Grace ND, Burroughs AK, Planas R, et al. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med 2005;353(21);2254-61.
พูลชัย จรัสเจริญวิทยา, วันรัชดา คัชมาตย์, ณสิกาญจน์ อังคเศกวินัย, ไกรวิพร เกียรติสุนทร, บรรณาธิการ. อายุรศาสตร์ทันยุค 2558 : update in internal medicine 2015 : best practice in internal medicine. กรุงเทพฯ : คณะแพทยศาสตร์ศิริราชพยาบาล มหาวิทยาลัยมหิดล; 2558.
Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007; 46(3): 922-38.
Abd-Elsalam S, Habba E, Elkhalawany W, Tawfeek S, Elbatea H, El-Kalla F, et al. Correlation of platelets count with endoscopic findings in a cohort of Egyptian patients with liver cirrhosis. Medicine 2016;95(23):e3853.
Rubin R, Strayer DS, Rubin E. Rubin’s pathology: clinicopathologic foundations of medicine. Philadelphia: Lippincott Williams & Wilkins; 2011.
Romcea AA, Tanţău M, Seicean A, Pascu O. The etiology of upper gastrointestinal bleeding in cirrhotic patients. Clujul Med 2013;86(1):21-3.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Journal of Preventive Medicine Association of Thailand
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
บทความที่ลงพิมพ์ในวารสารเวชศาสตร์ป้องกันแห่งประเทศไทย ถือเป็นผลงานวิชาการ งานวิจัย วิเคราะห์ วิจารณ์ เป็นความเห็นส่วนตัวของผู้นิพนธ์ กองบรรณาธิการไม่จำเป็นต้องเห็นด้วยเสมอไปและผู้นิพนธ์จะต้องรับผิดชอบต่อบทความของตนเอง
