1Junior Resident, Department of General Medicine, Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chennai, India. Ph number: 9342720726. Email: deepakraj.maa@gmail.com. Orcid id: 0009-0000-6427-3719
2Associate Professor, Department of General Medicine, Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chennai, India. Ph number: 8072250460. Email: smart.uma89@gmail.com. Orcid ID: 0000-0001-5837-2382
3Assistant Professor, Department of General Medicine, Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chennai, India. Ph number: 63699 40241. Email: aishwaryavenkat2193@gmail.com. Orcid ID: 0009-0004-4686-8822
4Assistant Professor, Department of General Medicine, Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chennai, India. Ph number: 99434 43752. Email: drrazookfareedh@gmail.com. Orcid ID: 0009-0009-9622-9574
5Assistant Professor, Department of General Medicine, Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chennai, India. Ph number: 6374303270. Email: rsaketh1992@gmail.com. Orcid ID: 0000-0002-0872-5191
Background: Portal hypertension is a common and serious complication of liver cirrhosis that leads to the development of portosystemic collateral circulation, including esophageal varices. Variceal hemorrhage remains one of the most severe and life-threatening consequences of cirrhosis and contributes significantly to morbidity and mortality. Although upper gastrointestinal endoscopy is the gold standard for the detection and grading of esophageal varices, routine endoscopic screening for all cirrhotic patients may not be feasible in many clinical settings due to cost, invasiveness, and limited availability of endoscopic facilities. Splenomegaly and thrombocytopenia are common manifestations of portal hypertension. The platelet count–splenic diameter ratio (PSDR) integrates these two parameters and has been proposed as a simple, inexpensive, and non-invasive predictor of esophageal varices.
Objective: To evaluate the platelet count–splenic diameter ratio as a non-invasive predictor of the presence and severity of esophageal varices using Paquet classification in patients with cirrhosis.
Methods: This hospital-based cross-sectional study was conducted in the Department of General Medicine at Sree Balaji Medical College and Hospital, Chennai, between July 2024 and December 2025. Eighty adult patients with clinically and radiologically diagnosed cirrhosis were included in the study. Platelet counts were measured using standard hematological methods, and splenic diameter was assessed through ultrasonography along the longest axis. The platelet count–splenic diameter ratio was calculated for each patient. Upper gastrointestinal endoscopy was performed to detect and grade esophageal varices according to Paquet classification.
Results: Among the 80 patients studied, esophageal varices were identified in 72 patients (90%). According to Paquet classification, Grade I varices were observed in 10 patients (12.5%), Grade II in 14 patients (17.5%), Grade III in 18 patients (22.5%), and Grade IV in 30 patients (37.5%). Eight patients (10%) had no esophageal varices. The mean platelet count–splenic diameter ratio was significantly lower in patients with esophageal varices compared to those without varices. A progressive decline in PSDR was observed with increasing grades of varices.
Conclusion: The platelet count–splenic diameter ratio is a simple, inexpensive, and reliable non-invasive marker for predicting both the presence and severity of esophageal varices in patients with cirrhosis. PSDR may help identify patients who require early endoscopic evaluation, particularly in resource-limited settings.
How to cite this article: Raj D, Umashankar R, Lakshmi MV A, Fareedh R, Ramineni S. Platelet Count–Splenic Diameter Ratio as a Non-Invasive Predictor of Esophageal Varices Using Paquet Classification in Patients with Cirrhosis: A Cross-Sectional Study. Int J Drug Deliv Technol. 2026;16(13s): 373-378. DOI: 10.25258/ijddt.16.13s.40
Source of support: Nil.
Conflict of interest: None