Platelet Count/Spleen Volume Ratio Is A Good Predictor Of Esophageal Varices In Patients With Hepatitis B Cirrhosis

Background: Gastroesophageal varices is a complication characterized by swollen or enlarged veins that progress at a rate of approximately 7-8% per year,with small varices progressing to large varices at a rate of 10-12% per year.Gastroesophageal varices bleeding is a common adverse consequence of portal hypertension and a major cause of disability and death in cirrhotic patients.Approximately 25-30% of cirrhotic patients develop variceal bleeding,which occurs at a rate of 5% per year and has a six-week mortality rate of 15-25%.The gold standard for the diagnosis of gastroesophageal varices is esophagogastroduodenoscopy,and clinical guidelines recommend diagnostic gastroscopy every 2 to 3 years for patients without varices and repeat gastroscopy every 1 to 2 years for patients with small varices.However,gastroscopy is an invasive and relatively expensive test that comes with many risks and cannot be a routine test to evaluate the occurrence and progression of gastroesophageal varices in patients with cirrhosis in whom the presence of gastroesophageal varices is not known.For the first time,the Baveno-VI consensus recommends the use of non-invasive tools to exclude varices with a high risk of bleeding.Currently,there are many diagnostic methods available for the noninvasive prediction of gastroesophageal varices,among which the platelet count/spleen longest diameter ratio（PSDR）is widely used in clinical practice due to its good performance in predicting esophageal varices（EV）.Objective: The purpose of this study was to evaluate the clinical value of platelet count/spleen volume ratio（PSVR）and spleen volume in predicting EV in patients with hepatitis B cirrhosis.Methods: This study was a diagnostic accuracy experiment and retrospective,and patients with hepatitis B cirrhosis who met the criteria in the Department of Gastroenterology of Xiangyang First People’s Hospital,affiliated with Hubei University of Medicine,from May 2016 to September 2020 were selected as study subjects,after excluding cases that might affect the results,all patients were collected blood samples in the morning on an empty stomach within 2 days,and related indicators were tested.Within 10 days,they received electronic gastroscopy and abdominal magnetic resonance examination.The spleen was analogized to a long ellipsoid,and the width and thickness of the maximum cross-section of the spleen were obtained using magnetic resonance imaging to calculate the length of the spleen and generate five parameters: PSVR,PSDR,spleen volume,spleen diameter,and platelet count.According to the Child-Pugh score,the patients were divided into groups with or without EV and with or without high-risk esophageal varices（HRV）,then statistical analysis of the two groups was performed.Results: A total of 199 patients with hepatitis B cirrhosis were included in the study,and five parameters（PSVR,PSDR,spleen volume,spleen diameter,and platelet count）were statistically significant in either the esophageal varices group or the high-risk esophageal varices group（P<0.001）.The area under the receiver operating characteristic curve（AUSROC）of PSVR in predicting EV or HRV in each group（85.5%-92.6%）was higher than PSDR,spleen volume,spleen diameter,and platelet count,PSVR outperformed PSDR in diagnostic performance when identifying EV（P=0.035）.The AUSROC of PSDR in diagnosing HRV was higher than spleen volume,and the AUSROC of spleen volume in diagnosing EV was higher than PSDR,but the difference was not significant（P>0.05）.In Child-Pugh A patients,Multivariate logistic regression analysis showed PSVR could be a predictor of HRV（P<0.05）,spleen volume was a reliable predictor of EV（P<0.05）.Conclusion: PSVR is better than PSDR,spleen diameter,platelet count in predicting EV;in the absence of serological results,spleen volume could be used instead of PSDR.Both can predict EV or HRV of patients with hepatitis B cirrhosis.