Value of platelet count and gallbladder wall thickness in predicting esophageal varices in patients with liver cirrhosis

• Main Author: DUAN Zhihui
• Format: Article
• Language: zho
• Published: Editorial Department of Journal of Clinical Hepatology 2019-12-01
• Series: Linchuang Gandanbing Zazhi
• Online Access: http://www.lcgdbzz.org/qk_content.asp?id=10394
• ISSN: 1001-5256; 1001-5256

ObjectiveTo investigate the value of platelet count (PLT) and gallbladder wall thickness (GBWT) in predicting esophageal varices (EV) in patients with liver cirrhosis. MethodsA retrospective analysis was performed for the clinical data of 100 patients who were diagnosed with hepatitis B cirrhosis in Xingtai People’s Hospital from January 2018 to January 2019, and according to the results of gastroscopy as the gold standard for EV, these patients were divided into non-EV group with 50 patients and EV group with 50 patients. All patients underwent abdominal ultrasound (including GBWT, portal vein diameter, and spleen length), gastroscopy, and serological examination. The independent samples t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. A multivariate logistic regression analysis was used to screen out the noninvasive indices for predicting EV in liver cirrhosis. The receiver operating characteristic (ROC) curve was used to compare the diagnostic efficiency of a single index and combined indices. ResultsCompared with the non-EV group, the EV group had significantly higher GBWT, portal vein diameter, and spleen length (Z=-6.251 and -2.611, t=-3.657, all P<0.01) and significantly lower PLT, PGR, and PLT-to-spleen length ratio (Z=-5.403, -7.018, and -6.015, all P<0.001). At the optimal cut-off value of 0.44 cm, GBWT had an area under the ROC curve (AUC) of 0.861 (95% confidence interval: 0.784-0.938), a sensitivity of 0.76, a specificity of 0.86, a positive predictive value of 0.86, and a negative predictive value of 0.78 in the diagnosis of EV in hepatitis B cirrhosis. In the diagnosis of EV, PGR had an AUC of 0.907, a sensitivity of 0.90, a specificity of 0.82, a positive predictive value of 0.91, and a negative predictive value of 0.84; in the diagnosis of high-risk EV, PGR had an AUC of 0.823, a sensitivity of 068, a specificity of 0.88, a positive predictive value of 0.89, and a negative predictive value of 0.86. With the criteria of GBWT<0.47 cm and PLT≥83×109/L, 46% of all patients (46/100) had no need for gastroscopy at the moment. ConclusionGBWT is expected to become a new index for predicting EV. Hepatitis B cirrhosis patients with GBWT<0.47 cm and PLT≥83×109/L have a low probability of EV, and thus it is recommended to postpone gastroscopy. The combination of these two noninvasive indices can provide a simple preliminary screening tool for clinicians to rule out esophageal varices in cirrhosis.