The Utility of Platelet Count to Spleen Bipolar Length Ratio as a Noninvasive Parameter for the Diagnosis of Esophageal Varices in Liver Cirrhosis

Introduction: Numerous efforts have been made to identify parameters capable of noninvasively predicting the presence of esophageal varices (EVs). This study aimed to assess the usefulness of the platelet count to spleen bipolar length ratio (PSR) as a noninvasive diagnostic tool for EVs in patients with liver cirrhosis. Materials and Methods: This cross-sectional observational study included eighty patients aged 18 years and older with liver cirrhosis, conducted from February 2024 to February 2025 at a tertiary care hospital in Western India. All participants underwent complete blood counts, ultrasonography, transient elastography (Fibroscan), and upper gastrointestinal endoscopy. PSR and Child–Pugh scores were calculated. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal PSR cut-off value for predicting EVs. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were evaluated. Results: ROC curve analysis demonstrated that PSR is a significant predictor for the development of EVs, with an area under the curve of 0.899 ( P = 0.0001). The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of the PSR with a cutoff value of ≤909 for predicting EVs were 93.4%, 89.5%, 95.0%, 85.0%, and 92.5%, respectively. Conclusions: PSR serves as an effective noninvasive diagnostic tool for EVs, particularly valuable in resource-limited settings and regions lacking access to endoscopy facilities.