Background/Aims: Cirrhosis represents a late stage of progressive hepatic fibrosis and is generally considered to be irreversible in its advanced stages. Esophageal varix is a complication of liver cirrhosis and is the consequence of portal hypertension. The aim of this study was to determine the correlation between the severity of thrombocytopenia and the presenting of esophageal varices (EVs) in cirrhotic patient. Patients and Methods: This study was a retrospective, descriptive, analytic and monocentric study, which was carried out at Gastroenterology Department, Khmer Soviet Friendship Hospital, Phnom Penh, Cambodia. It was conducted from 1st September 2020 to 31 st January 2021. All patients were diagnosed as liver cirrhosis by clinic, biology and ultrasound. Patients’ data were noted in standardized questionnaire with information such as age, sex, address, laboratory result, and the result of endoscopic finding. All data were registered into a data set and then analyzed by SPSS program version 23. Results: 1445 patients were enrolled for gastroscopy. Only 303 patients (21%) were suggested for variceal screening after the exclusions. Male was predominant with sex ratio F/M (1/2.03). Patients’ age varied between 21 and 80 years old, with the mean age of 55 ± 11 years old. 199 patients (66%) were found with EVs, while EVs grade 1 and 2 without red signs were predominated, accounting to 22.8% and 19.5% respectively. The majority of the patients with platelet count between 50 - 99 giga/l had EVs vs platelet count > 150 giga/l had no EVs (p < 0.0001). The cut-off level of platelet with EVs was 123 giga/l with 75% sensitivity and 65% specificity and with large varices was 105 giga/l with 70% sensitivity and 63% specificity. Conclusion: Thrombocytopenia is a non-invasive parameter with high accuracy for the prediction of EVs in cirrhosis. The severity of thrombocytopenia increased as the grading of EVs increased. Thus, it can assist in triaging cirrhotic patients for endoscopy to identify EVs.
Tsochatzis, E.A., Bosch, J. and Burroughs, A.K. (2014) Liver Cirrhosis. The Lancet, 383, 1749-1761. https://doi.org/10.1016/S0140-6736(14)60121-5
D’Amico, G., Garcia-Tsao, G. and Pagliaro, L. (2006) Natural History and Prognostic Indicators of Survival in Cirrhosis: A Systematic Review of 118 Studies. Journal of Hepatology, 44, 217-231. https://doi.org/10.1016/j.jhep.2005.10.013
Thapa, P.B., et al. (2015) Clinical Correlation between Child Pugh’s Score and Oesophageal Varices in Upper Gastrointestinal Endoscopy in Cirrhotic Patient. Journal of Kathmandu Medical College, 4, 135-139. https://doi.org/10.3126/jkmc.v4i4.18255
Duah, A., Nkrumah, K.N. and Tachi, K. (2018) Oesophageal Varices in Patients with Liver Cirrhosis Attending a Major Tertiary Hospital in Ghana. The Pan African Medical Journal, 31, Article 230. https://doi.org/10.11604/pamj.2018.31.230.16657
Garcia-Tsao, G., et al. (2007) Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis. American Journal of Gastroenterology, 102, 2086-2102. https://doi.org/10.1111/j.1572-0241.2007.01481.x
Laine, L., et al. (2021) ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Official Journal of the American College of Gastroenterology ACG, 116, 899-917. https://doi.org/10.14309/ajg.0000000000001245
Gralnek, I.M., Barkun, A.N. and Bardou, M.J. (2008) Management of Acute Bleeding from a Peptic Ulcer. New England Journal of Medicine, 359, 928-937. https://doi.org/10.1056/NEJMra0706113
Pongprasobchai, S., et al. (2009) Upper Gastrointestinal Bleeding Etiology Score for Predicting Variceal and Non-Variceal Bleeding. World Journal of Gastroenterology: WJG, 15, 1099-1104. https://doi.org/10.3748/wjg.15.1099
Grgurević, I., et al. (2014) Low Specificity of Platelet to Spleen Ratio for Noninvasive Prediction and Characterization of Esophageal Varices in Patients with Alcoholic Liver Cirrhosis. Acta Medica Croatica, 68, 353-360.
Afdhal, N., et al. (2008) Thrombocytopenia Associated with Chronic Liver Disease. Journal of Hepatology, 48, 1000-1007. https://doi.org/10.1016/j.jhep.2008.03.009
Abbasi, A., et al. (2010) Correlation of Thrombocytopenia with Grading of Esophageal Varices in Chronic Liver Disease Patients. Journal of College of Physicians and Surgeons Pakistan, 20, 369-372.
Hayashi, H., et al. (2014) Management of Thrombocytopenia Due to Liver Cirrhosis: A Review. World Journal of Gastroenterology: WJG, 20, 2595-2605. https://doi.org/10.3748/wjg.v20.i10.2595
Abd-Elsalam, S., et al. (2016) Correlation of Platelets Count with Endoscopic Findings in a Cohort of Egyptian Patients with Liver Cirrhosis. Medicine, 95, e3853. https://doi.org/10.1097/MD.0000000000003853
Perazzo, H., et al. (2015) Points to be Considered When Using Transient Elastography for Diagnosis of Portal Hypertension According to the Baveno’s VI Consensus. Journal of Hepatology, 63, 1048-1049. https://doi.org/10.1016/j.jhep.2015.06.036
Chang, P.E., et al. (2015) Epidemiology and Clinical Evolution of Liver Cirrhosis in Singapore. Annals of the Academy of Medicine of Singapore, 44, 218-225. https://doi.org/10.47102/annals-acadmedsg.V44N6p218
Topdagi, O., Okcu, N. and Bilen, N. (2014) The Frequency of Complications and the Etiology of Disease in Patients with Liver Cirrhosis in Erzurum. The Eurasian Journal of Medicine, 46, 110-114. https://doi.org/10.5152/eajm.2014.25
Lohana, R.K., et al. (2019) Severity of Thrombocytopenia with Different Grades of Esophageal Varices in Chronic Liver Disease Patients Undergoing Gastroscopy’s in a Tertiary Care Hospital. The Professional Medical Journal, 26, 1742-1747. https://doi.org/10.29309/TPMJ/2019.26.10.4134
Khy, M. (2021) The Correlation of Thrombocytopenia with Grading of Esophageal Varices among 291 Cirrhotic Patients in Liver and Gastrointestinal Unit at Calmette Hospital during 2 Years from 1st January 2016 to 31st December 2017, in Medecine. University of Health Sciences: Phnom Penh, Cambodia.
Altmaier, E.M. and Hansen, J.-I.C. (2012) The Oxford Handbook of Counseling Psychology. Oxford University Press, Oxford. https://doi.org/10.1093/oxfordhb/9780195342314.001.0001
Bouglouga, O., et al. (2013) Evaluation du coût financier direct de la prise en charge de la cirrhose et de ses complications dans le service d’Hépato-Gastro-Entérologie du CHU Campus de Lomé (Togo). La Revue Médicale de Madagascar, 3, 235-239.
Khan, F., et al. (2011) Hepatitis B Virus Infection among Different Sex and Age Groups in Pakistani Punjab. Virology Journal, 8, Article No. 225. https://doi.org/10.1186/1743-422X-8-225
Nunes, H. (2004) Prise en charge du syndrome hépatopulmonaire. Gastroentérologie clinique et biologique, 28, 156-168. https://doi.org/10.1016/S0399-8320(04)95251-7
Stroffolini, T., et al. (2017) Characteristics of liver Cirrhosis in Italy: Evidence for a Decreasing Role of HCV Aetiology. European Journal of Internal Medicine, 38, 68-72. https://doi.org/10.1016/j.ejim.2016.10.012
Amouretti, M., et al. (2000) Prise en charge des hémorragies digestives hautes communautaires: Trajectoires des malades dans 4 départements français. Gastroentérologie Clinique et Biologique, 24, 1003-1011.
Priyadarshi, B., et al. (2020) To Study the Association between Splenic Size and Grades of Oesophageal Varices in Patients of Cirrhosis of Liver with Portal Hypertension. Journal of Evolution of Medical Dental Sciences, 9, 1022-1026. https://doi.org/10.14260/jemds/2020/220
Lavanchy, D. and Hepatitis, B. (2004) Virus Epidemiology, Disease Burden, Treatment, and Current and Emerging Prevention and Control Measures. Journal of Viral Hepatitis, 11, 97-107. https://doi.org/10.1046/j.1365-2893.2003.00487.x
Marcellin, P. and Kutala, B.K. (2018) Liver Diseases: A Major, Neglected Global Public Health Problem Requiring Urgent Actions and Large-Scale Screening. Liver International, 38, 2-6. https://doi.org/10.1111/liv.13682
El-Din Nouh, M.A., El-Momen Ali, K.A., Badawy, A.M. and El-Daly, A.H. (2018) Correlation of Thrombocytopenia with Grading of Esophageal Varices in Chronic Liver Disease Patients. Menoufia Medical Journal, 31, 588-593.
Gill, M., et al. (2004) Non-Endoscopic Parameters for the Identification of Esophageal Varices in Patients with Chronic Hepatitis. Small, 28, Article 28.
Rani, K.V.L.S., Sudarsi, B., Siddeswari, R. and Manohar, S. (2015) Correlation of Portal Vein Size with Esophageal Varices Severity in Patients with Cirrhosis of Liver with Portal Hypertension. International Journal of Scientific and Research Publications, 5, 1-5.
Thomopoulos, K.C. (2011) Non-Invasive Prediction of Esophageal Varices: Is It Possible? Saudi Journal of Gastroenterology, 17, 1-3. https://doi.org/10.4103/1319-3767.74426
Sarwar, S., et al. (2005) Non-Endoscopic Prediction of Presence of Esophageal Varices in Cirrhosis. Journal of the College of Physicians Surgeons-Pakistan: JCPSP, 15, 528-531.
Cherian, J.V., Deepak, N., Ponnusamy, R.P., Somasundaram, A. and Jayanthi, V. (2011) Non-Invasive Predictors of Esophageal Varices. Saudi Journal of Gastroenterology, 17, 64-68. https://doi.org/10.4103/1319-3767.74470