Comparative Accuracy of Platelet Count/Spleen Diameter Ratio With Childturcotte-Pugh Score in Predicting Esophageal Varices Among Cirrhotic Patients: A Cross-Sectional Study

Background: Esophageal varices (EV) are a life-threatening complication of liver cirrhosis.While endoscopy is the diagnostic gold standard, it is invasive and resource-intensive1. Non-invasive tools such as the platelet count to spleen diameter (PC/SD) ratio and Child-Turcotte-Pugh (CTP) classification may offer alternatives for screening2. Objective: To compare the diagnostic accuracy of the PC/SD ratio and the CTP score in predicting the presence and severity of esophageal varices in patients with cirrhosis. Methods: In this cross-sectional observational study,66 cirrhotic patients underwent clinical evaluation,laboratory testing, abdominal ultrasonography, and esophagogastroduodenoscopy.The PC/SD ratio and CTP score were calculated.Correlation,ROC analysis,and diagnostic performance metrics (sensitivity, specificity, AUC) were used to evaluate predictive ability. Results: The presence of EV correlated significantly with both lower PC/SD ratio (r = –0.78,p < 0.001) and higher CTP class.The PC/SD ratio ≤950 demonstrated a sensitivity of 92.5% and specificity of 88% (AUC: 0.92). In comparison, CTP classification alone showed a weaker correlation with variceal grade (p < 0.05) and lower diagnostic precision (AUC: 0.76). Conclusion: The PC/SD ratio is a more accurate non-invasive predictor of esophageal varices than the CTP score. It offers a reliable, simple, and cost-effective tool for triaging cirrhotic patients,especially in low-resource settings.