Platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices: Results of a multicenter, prospective, validation study
Platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices: Results of a multicenter, prospective, validation study
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DOI：
10.1111/j.1572-0241.2006.00874.x
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发表时间：
2006-11-01
影响因子：
9.8
通讯作者：
Testa, Roberto
中科院分区：
文献类型：
--
作者：
Giannini, Edoardo G.;Zaman, Atif;Testa, Roberto
背景和目的：食管静脉曲张（EV）的无创评估可以改善肝硬化患者的管理，减少与筛查相关的医疗和经济负担。在这项多中心的国际研究中，我们的目的是前瞻性地验证血小板计数/脾脏直径比在EV无创诊断中的应用。方法：共有218名肝硬化患者接受了EV的内镜筛查。评估所有患者血小板计数/脾脏直径比(N/mm(3))/mm)并计算其诊断准确性。在先前结果的基础上，对该人群应用血小板计数/脾脏直径比截止值为909。进一步评估血小板计数/脾脏直径比值对疾病亚组的严重程度和病因的诊断准确性。结果：EV患病率为54.1%。血小板计数/脾脏直径比值对EV的诊断准确率为86.0% (95% CI, 80.7 ~ 90.4%)，显著高于单独使用血小板计数（83.6%,95% CI 78.0 ~ 88.3%, P = 0.038）或单独使用脾脏直径（80.2%,95% CI 74.3 ~ 85.3%, P = 0.018）。909临界值诊断EV的敏感性为91.5% (95% CI 85.0 ~ 95.9%)，特异性为67.0% (95% CI 56.9 ~ 76.1%)，阳性预测值为76.6%，阴性预测值为87.0%，阳性似然比为2.77，阴性似然比为0.13。对于疾病亚组的严重程度和病因，血小板计数/脾脏直径比值的准确性保持不变。结论：血小板计数/脾脏直径比值可作为一种安全且可重复的方法，改善应接受内窥镜筛查EV的肝硬化患者的管理。
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.