Giannini et al used the ratio of the platelet count to splenic diameter to identify a patient with cirrhosis who may have esophageal varices. This can help identify those patients who may require more expensive endoscopic or imaging procedures for diagnosis and monitoring. The authors are from the University of Genoa in Italy.


Patient selection: adult with cirrhosis (most etiologies represented)



(1) platelet count per µL (tends to be low with varices, typically due to splenomegaly)

(2) bipolar splenic diameter on ultrasound in mm (tends to be increased with varices due to portal hypertension)


platelet count to spleen diameter ratio =

= (platelet count per µL) / (spleen diameter in mm)



• minimum ratio: around 100

• maximum ratio: around 5,000

• A patient with a ratio <= 909 was at significant risk for esophageal varices.



• The sensitivity was 100% at a cutoff of <= 909, with specificity of 71%.

• The area under the ROC curve (c index) was 0.921.


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