Platelet Count/Spleen Diameter Ratio and Serum Ascites Albumin Gradient for Screening Parameters of Esophageal Varices in Decompensated Hepatic Cirrhosis: An Observational Study

Introduction: In low- and middle-income countries like Nepal, with limited resources, the oesophagogastroduodenoscopy facility may not be available widely due to its high cost and availability constraints. Most of the studies done to predict the presence of esophageal varices in cirrhotic patients are on either serum ascites albumin gradient or platelet count to splenic diameter as the noninvasive parameter. This study aims to assess the platelet count to splenic diameter ratio and serum ascites albumin gradient as non-invasive screening parameters for esophageal varices in patients with decompensated hepatic cirrhosis and ascites. Methods: A cross-sectional analytical study was conducted recruiting decompensated chronic liver disease patients, aged 18 to 65 years, having no previous or recent endoscopic diagnosis of esophageal varices from June to December 2022 using a purposive sampling method. Serum ascites albumin gradient, platelet count, spleen diameter by abdominal ultrasonogram, and platelet count to splenic diameter ratio were calculated. Later upper gastrointestinal endoscopy was performed to confirm the presence of esophageal varices. Results: Among 150 enrolled patients, 110 (73.33%) had esophageal varices. Of the cases of esophageal varices, 80% had high SAAG, and 68.18% had low platelet count to splenic diameter ratio. SAAG (≥ 1.1 g/dl) alone had a balanced sensitivity of 80% and specificity of 85%. Conclusions: Serum ascites albumin gradient and platelet count to splenic diameter ratio could be considered as a non-invasive screening parameter of esophageal varices in low-resource settings as a low-cost alternative.