KOWSAR Article Type: Original article Article history: Received: 14 Sep 2010 Revised: 04 Dec 2010 Accepted: 11 Dec 2010 Keywords: Cirrhosis Platelet count Bipolar disorders Spleen Hepat Mon. 2011;11(4):278-284 Journal home page: www.HepatMon.ir Platelet count/bipolar spleen diameter ratio for the prediction of esopha- geal varices: The special Egyptian situation Mona A. Abu El Makarem 1*, Mohamed E. Shatat 1, Yehya Shaker 1, Ahmad A. Abdel Aleem 1, Ali M. El Sherif 1, Maysa Abdel Moaty 1, Hosny S. Abdel Ghany 2, Atef Elakad 1, Amal M. Kamal Eldeen 3 1 Department of Internal Medicine, Minia University, Minya, Egypt 2 Department of Radiology, Minia University, Menia, Egypt 3 Department of Clinical pathology, Minia University, Minya, Egypt A R T I C L E I N F O A B S T R A C T Background: Esophageal variceal hemorrhage is a devastating complication of portal hypertension that occurs in approximately one-third of cirrhotic patients. Objectives: We assessed the value of the platelet count/ bipolar spleen diameter ratio as a noninvasive parameter for the prediction of esophageal varices (EVs) in Egyptian cirrhotic patients. Patients and Methods: Laboratory and ultrasonographic and imaging variables were prospectively evaluated in 175 patients with liver cirrhosis. All patients underwent up- per gastrointestinal endoscopy. Patients with active gastrointestinal bleeding at the time of admission were excluded. Results: The platelet count/ bipolar spleen diameter ratio in patients with EVs was sig- nificantly lower than in patients without EVs. In an analysis of the receiver operating characteristic curves (ROCs), we calculated an optimal cutoff value of 939.7 for this ra- tio, which gave 100% sensitivity and negative predictive values, 86.3% specificity, a 95.6% positive predictive value, and an area under the ROC curve of 0.94 ± 0.02, reflecting its overall diagnostic accuracy. These findings were extended to a subset analysis of compensated cirrhotic patients. Conclusions: The platelet count/ bipolar spleen diameter ratio has excellent accuracy in the noninvasive assessment of EVs in patients with compensated or decompensated liver cirrhosis. It is easy to calculate and can lower the financial and sanitary burdens of endoscopy units, especially in developing countries. c 2011 Kowsar M.P.Co. All rights reserved. Implication for health policy/practice/research/medical education: Exploring well-validated non invasive tools for the prediction of esophageal varicesmay be useful as afirst line tool to identify cirrhotic patients in which the risk ofclinically relevant OV is trivial, and to reduce the number ofupper endoscopies. Noninvasive methods play an important role in diagnosis of severity in liver diseases. Reading this article is recommended to all internists, gastroenterologists and hepatologists. Please cite this paper as: Abu El Makarem MA, Shatat ME, Shaker Y, Abdel Aleem AA, El Sherif AM, Abdel Moaty M, et al. Platelet count/bipolar spleen diameter ratio for the prediction of esophageal varices: The special Egyptian situation. Hepat Mon.2011;11(4):278-84. * Corresponding author at: Mona Abu El Makarem, Internal Medicine Department, Minia University, Minia 61111, Egypt. Tel: +20-862366553, Fax: +20-86242813. E-mail: mona.makarem@yahoo.com c 2011 Kowsar M.P.Co. All rights reserved. Background Portal hypertension and esophageal varices (EVs) are common major complications of liver cirrhosis, oc- curring in approximately 24% to 80% of cases, with an