Correlation between Platelet Count and Grading of Esophageal Varices in Liver Cirrhosis Patients: A Meta-Analysis

Authors

  • Fahri Ahmad Baihaqi Serui General Hospital, Kepulauan Yapen, Papua, Indonesia https://orcid.org/0000-0001-6424-5515
  • Dinda Olinda Delarosa Dr. Sitanala General Hospital, Tangerang, Banten, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2022.9058

Keywords:

Cirrhosis, Esophageal varices, Platelet

Abstract

BACKGROUND: Esophageal varices are a major complication of liver cirrhosis. Esophageal varices bleeding is life-threatening and an urgent medical emergency. Low platelet count and esophageal varices are common findings in liver cirrhosis. Platelet count is suggested as a non-invasive screening tool to predict the grading of esophageal varices in liver cirrhosis patients. Several studies have found a correlation between platelet count and grading of esophageal varices in liver cirrhosis patients. However, the results are conflicting.

AIM: This meta-analysis aimed to evaluate the correlation between platelet count and the grading of esophageal varices in liver cirrhosis patients.

METHODS: A systematic literature search was performed through the database search from PubMed, SCOPUS, Ovid EMBASE, and EuropePMC to obtain all relevant articles with the following search terms: "correlation" and "platelet" or "thrombocytopenia" AND "esophageal varices" and "liver cirrhosis" or "chronic liver disease" that were published within the year of 2000-2021. Articles were collected by using PRISMA flow diagrams. The data were extracted from the eligible study within inclusion and exclusion criteria. The quality of each study was assessed using the Newcastle Ottawa Scale (NOS). A meta-analysis was conducted to determine the overall pooled correlation coefficient (r) and 95% confidence interval (CI).

RESULTS: There were a total of 1008 patients from eight included studies. The meta-analysis showed that the pooled correlation coefficient between platelet count and grading of esophageal varices in liver cirrhosis patients was r = -0.42 (95%CI -0.65 to -0.13; p = 0.005; I2 = 96.06%).

CONCLUSION: There was a moderate negative correlation between platelet count and grading of esophageal varices. Thus, low platelet count may indicate higher grades of esophageal varices in liver cirrhosis patients.

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References

Rye K, Scott R, Mortimore G, Lawson A, Austin A, Freeman J. Towards noninvasive detection of oesophageal varices. Int J Hepatol. 2012;2012:343591. http://doi.org/10.1155/2012/343591 PMid:22506126 DOI: https://doi.org/10.1155/2012/343591

GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385(9963):117-71. http://doi.org/10.1016/S0140-6736(14)61682-2 PMid:25530442 DOI: https://doi.org/10.1016/S0140-6736(14)61682-2

GBD 2017 Cirrhosis Collaborators. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol. 2020;5(3):245-66. http://doi.org/10.1016/S2468-1253(19)30349-8 PMid:31981519 DOI: https://doi.org/10.1016/S2468-1253(19)30349-8

Shin SU, Lee JM, Yu MH, Yoon JH, Han JK, Choi BI, et al. Prediction of esophageal varices in patients with cirrhosis: Usefulness of three-dimensional MR elastography with echo-planar imaging technique. Radiology. 2014;272(1):143-53. http://doi.org/10.1148/radiol.14130916 PMid:24620910 DOI: https://doi.org/10.1148/radiol.14130916

Kraja B, Mone I, Akshija I, Koçollari A, Prifti S, Burazeri G. Predictors of esophageal varices and first variceal bleeding in liver cirrhosis patients. World J Gastroenterol. 2017;23(26):4806-14. http://doi.org/10.3748/wjg.v23.i26.4806 PMid:28765702 DOI: https://doi.org/10.3748/wjg.v23.i26.4806

Al-Busafi SA, McNabb-Baltar J, Farag A, Hilzenrat N. Clinical manifestations of portal hypertension. Int J Hepatol. 2012;2012:203794. http://doi.org/10.1155/2012/203794 PMid:23024865 DOI: https://doi.org/10.1155/2012/203794

Ismail FW, Shah HA, Hamid S, Abbas Z, Abid S, Mumtaz K, et al. Noninvasive predictors of large varices in patients hospitalized with gastroesophageal variceal hemorrhage. Hepatol Int. 2008;2(1):124-8. http://doi.org/10.1007/s12072-007-9034-1 PMid:19669288 DOI: https://doi.org/10.1007/s12072-007-9034-1

Nada L, Samira el F, Bahija B, Adil I, Nourdine A. Noninvasive predictors of presence and grade of esophageal varices in viral cirrhotic patients. Pan Afr Med J. 2015;20:145. http://doi.org/10.11604/pamj.2015.20.145.4320 PMid:27386022 DOI: https://doi.org/10.11604/pamj.2015.20.145.4320

Jairath V, Rehal S, Logan R, Kahan B, Hearnshaw S, Stanworth S, et al. Acute variceal haemorrhage in the United Kingdom: Patient characteristics, management and outcomes in a nationwide audit. Dig Liver Dis. 2014;46(5):419-26. http://doi.org/10.1016/j.dld.2013.12.010 PMid:24433997 DOI: https://doi.org/10.1016/j.dld.2013.12.010

Javed M, Mohammad D, Masood Z, Sheikh G, Iftikhar M, Hamed A. To determine the correlation between mean platelet count and frequency of grading of esophageal varices in patients of liver cirrhosis. Prof Med J. 2021;28(6):833-41. https://doi.org/10.29309/TPMJ/2021.28.06.6258 DOI: https://doi.org/10.29309/TPMJ/2021.28.06.6258

D’Amico G, Morabito A. Noninvasive markers of esophageal varices: Another round, not the last. Hepatology. 2004;39(1):30-4. http://doi.org/10.1002/hep.20018 PMid:14752818 DOI: https://doi.org/10.1002/hep.20018

Liu H, Chen P, Jiang B, Li F, Han T. The value of platelet parameters and related scoring system in predicting esophageal varices and collateral veins in patients with liver cirrhosis. J Clin Lab Anal. 2021;35(3):e23694. http://doi.org/10.1002/jcla.23694 PMid:33389784 DOI: https://doi.org/10.1002/jcla.23694

Supriyanto I, Suyata S, Rasyad SB, Bakry F. Correlation between aspartate aminotransferase to platelet ratio index score and the degree of esophageal varices with liver cirrhosis. Indones J Gastroenterol Hepatol Dig Endosc. 2012;13(3):141-144. https://doi.org/10.24871/1332012141-144

Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology. 2017;65(1):310-35. http://doi.org/10.1002/hep.28906 PMid:27786365 DOI: https://doi.org/10.1002/hep.28906

de Franchis R, Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63(3):743-52. http://doi.org/10.1016/j.jhep.2015.05.022 PMid:26047908 DOI: https://doi.org/10.1007/978-3-319-23018-4_1

Tafarel JR, Tolentino LH, Correa LM, Bonilha DR, Piauilino P, Martins FP, et al. Prediction of esophageal varices in hepatic cirrhosis by noninvasive markers. Eur J Gastroenterol Hepatol. 2011;23(9):754-8. http://doi.org/10.1097/MEG.0b013e3283488a88 PMid:21691209 DOI: https://doi.org/10.1097/MEG.0b013e3283488a88

Giannini EG, Zaman A, Kreil A, Floreani A, Dulbecco P, Testa E, et al. Platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices: Results of a multicenter, prospective, validation study. Am J Gastroenterol. 2006;101(11):2511-9. http://doi.org/10.1111/j.1572-0241.2006.00874.x PMid:17029607 DOI: https://doi.org/10.1111/j.1572-0241.2006.00874.x

Sheikh MY, Raoufi R, Atla PR, Riaz M, Oberer C, Moffett MJ. Prevalence of cirrhosis in patients with thrombocytopenia who receive bone marrow biopsy. Saudi J Gastroenterol. 2012;18(4):257-62. http://doi.org/10.4103/1319-3767.98431 PMid:22824769 DOI: https://doi.org/10.4103/1319-3767.98431

Afsar A, Nadeem M, Shah SA, Hussain H, Rani A, Ghaffar S. Platelet count can predict the grade of esophageal varices in cirrhotic patients: A cross-sectional study. F1000Res. 2021;10:101. http://doi.org/10.12688/f1000research.28005.2 PMid:35035881 DOI: https://doi.org/10.12688/f1000research.28005.1

Abd-Elsalam S, Habba E, Elkhalawany W, Tawfeek S, Elbatea H, El-Kalla F, et al. Correlation of platelets count with endoscopic findings in a cohort of Egyptian patients with liver cirrhosis. Medicine (Baltimore). 2016;95(23):e3853. http://doi.org/10.1097/MD.0000000000003853 PMid:27281094 DOI: https://doi.org/10.1097/MD.0000000000003853

Nouh MA, Ali KA, Badawy AM, El-Daly AH. Correlation of thrombocytopenia with grading of esophageal varices in chronic liver disease patients. Menoufia Med J. 2018;31(2):588-93. https://doi.org/10.4103/1110-2098.239725

Lo C, Mertz D, Loeb M. Newcastle-Ottawa Scale: Comparing reviewers’ to authors’ assessments. BMC Med Res Methodol. 2014;14:45. https://doi.org/10.1186/1471-2288-14-45 PMid:24690082 DOI: https://doi.org/10.1186/1471-2288-14-45

Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5:13. http://doi.org/10.1186/1471-2288-5-13 PMid:15840177 DOI: https://doi.org/10.1186/1471-2288-5-13

Patsopoulos NA, Evangelou E, Ioannidis JP. Sensitivity of between-study heterogeneity in meta-analysis: Proposed metrics and empirical evaluation. Int J Epidemiol. 2008;37(5):1148-57. http://doi.org/10.1093/ije/dyn065 PMid:18424475 DOI: https://doi.org/10.1093/ije/dyn065

Sterne JA, Gavaghan D, Egger M. Publication and related bias in meta-analysis: Power of statistical tests and prevalence in the literature. J Clin Epidemiol. 2000;53(11):1119-29. http://doi.org/10.1016/s0895-4356(00)00242-0 PMid:11106885 DOI: https://doi.org/10.1016/S0895-4356(00)00242-0

Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al., editors. Cochrane Handbook for Systematic Reviews of Interventions Version 6.2 (Updated February 2021). Chichester (UK): Cochrane; 2021. Available from: https://www.training.cochrane.org/handbook [Last accessed on 2021 Oct 17].

Divya S, Nagarajan K, Thirumal P. A study of correlation between platelet count and severity of esophageal varices in patients with chronic liver disease. IOSR J Dent Med Sci. 2020;19(12):38-43. https://doi.org/10.9790/0853-1912013843

Abbasi A, Butt N, Bhutto AR, Munir SM. Correlation of thrombocytopenia with grading of esophageal varices in chronic liver disease patients. J Coll Physicians Surg Pak. 2010;20(6):369-72. http://doi.org/06.2010/JCPSP.369372 PMid:20642964

Gue CS, Yap CK, Ng HS. The correlation between cytopenia and esophageal varices in patients with liver cirrhosis. Med J Malaysia 2004;59(5):604-8.

Macaskill P, Walter SD, Irwig L. A comparison of methods to detect publication bias in meta-analysis. Stat Med. 2001;20(4):641-54. http://doi.org/10.1002/sim.698 PMid:11223905 DOI: https://doi.org/10.1002/sim.698

Hasan I, Jasirwan C, Loho I, Nababan S, Zulkifly S, Handayu A. Non-invasive predictors of moderate large esophageal varices in compensated cirrhotic patients. J Gastroenterol Hepatol Res. 2021;10(2):3478-82. https://doi.org/10.17554/j.issn.2224-3992.2021.10.1000

Sarangapani A, Shanmugam C, Kalyanasundaram M, Rangachari B, Thangavelu P, Subbarayan JK. Noninvasive prediction of large esophageal varices in chronic liver disease patients. Saudi J Gastroenterol. 2010;16(1):38-42. http://doi.org/10.4103/1319-3767.58767 PMid:20065573 DOI: https://doi.org/10.4103/1319-3767.58767

Sigal SH, Sherman Z, Jesudian A. Clinical Implications of Thrombocytopenia for the Cirrhotic Patient. Hepat Med. 2020;12:49-60. http://doi.org/10.2147/HMER.S244596 PMid:32341665 DOI: https://doi.org/10.2147/HMER.S244596

Kumar P, Singh K, Joshi A, Thakur P, Mahto SK, Kumar B, et al. Evaluation of non-invasive marker of esophageal varices in cirrhosis of liver. J Family Med Prim Care. 2020;9(2):992-6. http://doi.org/10.4103/jfmpc.jfmpc_854_19 PMid:32318456 DOI: https://doi.org/10.4103/jfmpc.jfmpc_854_19

Priyadarshi B, Khan I, Kumar V, Verma A, Midha T, Madhuri S, et al. Study the association between platelets count and grades of oesophageal varies in patients of cirrhosis of liver with portal hypertension. Int J Adv Med. 2020;7(4):603. https://doi.org/10.18203/2349-3933.Ijam20201108 DOI: https://doi.org/10.18203/2349-3933.ijam20201108

Miller JB, Figueroa EJ, Haug RM, Shah NL. Thrombocytopenia in Chronic Liver Disease and the Role of Thrombopoietin Agonists. Gastroenterol Hepatol (N Y). 2019;15(6):326-32.

Mitchell O, Feldman DM, Diakow M, Sigal SH. The pathophysiology of thrombocytopenia in chronic liver disease. Hepat Med. 2016;8:39-50. http://doi.org/10.2147/HMER.S74612 PMid:27186144 DOI: https://doi.org/10.2147/HMER.S74612

Saab S, Bernstein D, Hassanein T, Kugelmas M, Kwo P. Treatment options for thrombocytopenia in patients with chronic liver disease undergoing a scheduled procedure. J Clin Gastroenterol. 2020;54(6):503-11. http://doi.org/10.1097/MCG.0000000000001338 PMid:32195771 DOI: https://doi.org/10.1097/MCG.0000000000001338

Hasan SM, Dmitriew M, Leonard J. Variceal bleed and portal hypertensive gastropathy in a noncirrhotic patient with isolated splenomegaly. Case Reports Hepatol. 2020;2020:8893713. http://doi.org/10.1155/2020/8893713 PMid:33381333 DOI: https://doi.org/10.1155/2020/8893713

Brown RS Jr. Current management of thrombocytopenia in chronic liver disease. Gastroenterol Hepatol (N Y). 2019;15(3):155-7. PMid:31061657

Zaman A, Becker T, Lapidus J, Benner K. Risk factors for the presence of varices in cirrhotic patients without a history of variceal hemorrhage. Arch Intern Med. 2001;161(21):2564-70. http://doi.org/10.1001/archinte.161.21.2564 PMid:11718587 DOI: https://doi.org/10.1001/archinte.161.21.2564

Esmat S, Rashid L. A comparative study between three noninvasive predictors of oesophageal varices in post hepatitis C virus liver cirrhosis in Egypt. Acta Gastroenterol Belg 2011;74(4):497-502. PMid:22319958

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Published

2022-04-10

How to Cite

1.
Baihaqi FA, Delarosa DO. Correlation between Platelet Count and Grading of Esophageal Varices in Liver Cirrhosis Patients: A Meta-Analysis. Open Access Maced J Med Sci [Internet]. 2022 Apr. 10 [cited 2024 Mar. 29];10(F):513-21. Available from: https://oamjms.eu/index.php/mjms/article/view/9058

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Meta-analytic Review Article

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