Review Article

Platelet Count to Spleen Diameter Ratio for the Diagnosis of Gastroesophageal Varices in Liver Cirrhosis: A Systematic Review and Meta-Analysis

Table 1

Characteristics of studies.

First author (year)RegionsStudy designNumber of total PtsAge (year)Male (%)Etiology of cirrhosisHCC (%)Child-Pugh class (%)Location of varicesPrevalence of varices (%)Prevalence of high-risk/large varices (%)Cut-off of varices

Karatzas (2016)GreeceProspective386378.9%Alcohol 47.4%NAA, 55.3%EV + GV63.2%10.5%1310.597 (optimal)
Viral hepatitis 34.2%B, 28.9%
Others 18.4%C, 15.8%909

Kim (2016)South KoreaRetrospective10353.5 ± 11.865.0%Alcohol 28.2%NANAEV38.8%12.6%860
HBV 50.5%
HCV 8.7%
HBV and alcohol 7.8%
Others 4.9%

Takuma (2016)JapanProspective6070.8 ± 9.956.7%Alcohol 10%NAA, 68.3% 
B, 30% 
C, 1.7%
EV40.0%26.7%3.36
HBV 13.3%
HCV 58.3%
Others 18.3%

Xu (2016)ChinaProspective23661.4 ± 10.243.2%Schistosomiasis 100%NANAEV40.3%NA1004 (optimal)
909

Albreedy (2015)EgyptProspective10044.24 ± 7.0558.0%NA0%A, 41%EV66.0%47.0%979.9
B, 33%
C, 26%

Cho (2015)South KoreaRetrospective21991.8%Alcohol 100%0%A, 59.4%EV + GVNA33.3%NA
B, 36.1%
C, 4.6%

Stefanescu (2015)RomaniaCross-sectional9056.47 ± 9.38/55.6%Alcohol 33.3%0%A, 62.2% 
B, 35.6% 
C, 2.2%
EV81.1%52.2%NA
HBV 13.3%
HCV 33.3%
Others 20%

Valero (2015) (abstract)PhilippinesRetrospective10164.8/61.6NANA0%NAEV85.1%NA1.86

Zhao (2015)ChinaRetrospective12451.34 ± 11.08957.3%HCV 100%NANAEV51.6%NA909

Chiodi (2014)UruguayRetrospective1255456.8%Alcohol 40%0%NAEV63.2%42.4%1010%
HBV 3.2%
HCV 16.8%
Autoimmune 12%
Others 19.2%
Unknown 8.8

González-Ojeda (2014)MexicoCross-sectional9153.75 ± 1254.9%Alcohol 52.7%0%A, 18.7% 
B, 40.7% 
C, 40.7%
EV80.2%57.1%884
HCV 26.4%
Others 11%
Unknown 10%

Wang (2014) China Retrospective 104 59 56.7%Alcohol 17.3% NAA, 24% 
B, 35.6% 
C, 40.4%
EV 99.0% 51.9% NA
HBV 66.3%
Alcohol and HBV 12.5%
Unknown 3.8%

Zafar (2014)PakistanProspective21546.93 ± 13.2242.3%NANANAEV60.9%NA909

Calvaruso (2013)ItalyProspective9663.2 ± 9.569.8%HCV 100%0%A, 100%EV56.3%27.1%800

Masjedizadeh (2013)IranProspective14057/5370.0%Alcohol 3.6%NAA, 43.6% 
B, 42.1% 
C, 14.3%
EV85.0%33.6%663
HBV 36.4%
HCV 17.1%
Autoimmune 8.6%
Others 5.7%
Unknown 28.6%

Rajendran (2013) (abstract)IndiaCross-sectional101NA93.1%Alcohol 85%NANAEV95.0%65.0%NA
HBV 9%
HCV 5%

Saad (2013)EgyptNA3255 ± 6.6/49.5 ± 4.7/62.5%HCV 100%0%A, 71.9%EV62.5%31.3%545
48.9 ± 4.B, 28.1%

Sharma (2013)IndiaNA17449.3 ± 11.788.5%Alcohol 44.3%0%A, 31.6% 
B, 56.9% 
C, 11.5%
EV71.3%44.8%1023.2 (optimal) 
909
HBV 13.2%
HCV 16.7%
Unknown 25.9%

Al-Dahshan (2012)EgyptNA6052.62 ± 8.2278.3%HBV 81.7%0%NAEV66.7%NA1023
HCV 18.3%

Colecchia (2012)ItalyProspective1005471.0%HCV 100%0%A, 68% 
B, 32%
EV53.0%49.0%1883 (optimal)
513

Mahassadi (2012) Cote d’IvoireNA (training sample)1114970.3%Alcohol 20.7% 
HBV 61.3% 
HCV 12.6% 
Others 5.4%
0%A, 22.5% 
B, 35.1% 
C, 42.3%
EV76.6%70.3%868
NA (validation sample)915064.2%Alcohol 26.4% 
HBV 58.2% 
HCV 15.4%
0%A, 19.8% 
B, 52.7% 
C, 22% 
Unknown, 5.5%
EV79.1%65.9%868

Mangone (2012)ItalyProspective8762.858.6%Alcohol 8%NAA, 90.8% 
B, 6.9% 
Unknown, 2.3%
EV35.6%NA936.364 (optimal) 
909
HBV 10.5%
HCV 63.2%
Others 18.3%

Nisar (2012)PakistanCross-sectional15050.99 ± 12.9954.0%NANANAEV68.0%NA909

Abu El Makarem (2011)EgyptProspective1754865.7%HCV 100%NAA, 26.3%EV74.9%NA939.7
B, 33.7%
C, 40%

Agha (2011)ItalyProspective436170.0%Schistosomiasis 100%NANAEV72.1%44.2%885

Cherian (2011)IndiaProspective2294261.6%Alcohol 42.4%0%A, 18.3% 
B, 55.5% 
C, 26.2%
EV77.7%35.4%666
HBV 15.3%
HCV 10%
Others 12.7%
Unknown 19.7%

Esmat (2011)EgyptProspective10049.2 ± 848.0%HCV 100%NAA, 20%EV82.0%60.0%1326.6 (optimal) 
909
B, 31%
C, 49%

Mosqueira (2011)PeruRetrospective4760.7450.0%Alcohol 25.5%NANAEV74.5%46.8%909
HBV 2.1%
HCV 14.9%
Autoimmune 8.5%
Unknown 48.9%

Stefanescu (2011)RomaniaProspective1375656.2%Alcohol/HCV 100%NAA, 64.9%EV84.9%44.0%1068
B, 28.4%
C, 6.8%

Barikbin (2010)IranProspective5052.1 ± 16.282.0%Alcohol 4%0%A, 10% 
B, 28% 
C, 62%
EV74.0%62.0%921
HBV 38%
HCV 14%
Others 6%
Unknown 38%

De Mattos (2010) Brazil NA 164 56.6 ± 11.6 56.7%Alcohol 29.3% NAA, 57.6% 
B, 37.7% 
C, 4.6%
EV 73.2% 40.8% 909
Viral hepatitis 43.9%
Viral hepatitis and alcohol 10.4%
Others 16.5%

Nashaat (2010)EgyptNA5049.6 ± 8.874.0%HBV 20%NAA, 38%EV88.0%NA820
HCV 70%B, 42%
HBV and HCV 10%C, 20%

Sarangapani (2010)IndiaProspective1064567.9%Alcohol 58.5%0%NAEV72.6%48.1%NA%
HBV 21.7%
Others 19.8%

Schwarzenberger (2010)USRetrospective1375664.0%Alcohol 18%NANAEV55.5%18.2%909
HBV 23%
HCV 34%
Others 17%
Unknown 9

Agha (2009)PakistanProspective3114955.6%HCV 100%0%A, 25.8%EV49.5%12.9%909
B, 58.6%
C, 15.6%

Barrera (2009)ChileProspective6766 ± 12.243.3%Alcohol 26.9%NAA, 46.2% 
B, 38.8% 
C, 15%
EV85.1%49.3%NA
Viral hepatitis 7.5%
PBC 14.9%
Others 26.8%
Unknown 26.9%

Cammà (2009)ItalyProspective10461.4 ± 9.557.7%HCV 100%0%A, 100%EV60.6%NA792

Sharif (2009)PakistanCross-sectional100NA56.0%HBV 29%NANAEV50.0%NA2200
HCV 71%

Baig (2008)IndiaProspective1505184.0%Alcohol 48.7% 
HBV 26% 
HCV 9.3% 
Others 7.3% 
Unknown 8.7%
NAA, 64.7% 
B, 21.3% 
C, 14%
EV70.7%46.7%1014 (optimal)
909

Parrino (2008)ItalyNA15866.6 ± 9.663.3%NA0%A, 64%EV74.1%19.6%1300
B, 31%
C, 5%

Tao (2008)ChinaNA695363.8%HBV 100%NAA, 20.3%EV78.3%NA909
B, 63.8%
C, 15.9%

Yu (2008)ChinaRetrospective895382.0%HBV 100%NAA, 29.2%EV75.3%29.2%909
B, 42.7%
C, 28.1%

Lei (2007)ChinaRetrospective3265577.3%Alcohol 4.3% 
HBV 90.8% 
HBV and HBV 1.5% 
Others 3.4%
NAA, 14.7% 
B, 67.5% 
C, 17.8%
EV41.7%15.6%0.55 (optimal)
0.42

Giannini (2006) Italy Prospective 218 58.7%Alcohol 18.8% 8.7%A, 50.9% 
B, 34.4% 
C, 14.7%
EV 54.1% 21.6% 909
Viral hepatitis 48.2%
PBC 16.1%
Viral hepatitis and alcohol 12.4%
Others 4.6%

Legasto (2006)PhilippinesCross-sectional15070.7%Alcohol 90% 
HBV 10%
0%NAEV46.0%NA160 (optimal)
909

Sethar (2006)PakistanCross-sectional11337.1 ± 14.8569.0%HBV 33.6%NAA, 13.3% 
B, 60.2% 
C, 26.6%
EV58.4%NA1445
HCV 52.2%
HBV + HCV 7.1%
Others 7.1%

Giannini (2005)ItalyProspective6865 ± 1063.2%Viral, 77.9%NAA, 35.3%EV40.0%5.9%909
Nonviral, 22.1%B, 41.2%
C, 23.5%

Pleština (2005)CroatiaNA9953.6 ± 9.7678.8%HCV/HBV 13.1% 
Alcohol 83.9% 
PBC 3%
0%A, 20.2%EV100.0%53.5%NA
B, 53.5%
C, 25.3%
Unknown, 1%

Giannini (2003)ItalyRetrospective1456171.0%Alcohol 16.6% 
HBV 11% 
HCV 53.8% 
Others 18.6%
NAA, 37% 
B, 36% 
C, 27%
EV61.0%20.0%909
1216465.3%Alcohol 24%NAA, 41.3% 
B, 42.1% 
C, 16.5%
EV58.7%15.7%909
HBV 5%
HCV 63.6%
Others 7.4%

EV, esophageal varices; GV, gastric varices; HBV, hepatitis B virus; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; NA, not available; PBC, primary biliary cirrhosis; Pts, patients.
Notes. , age of patients was applied according to grade of varices or severity of cirrhosis.