Immature Platelet Fraction as a Non-Invasive Marker for Esophageal Varices
Alyaa Marzouk Soliman *
Department of Tropical Medicine and Infectious Diseases, Tanta University, Tanta, Egypt.
Sherief Mohamed Abd-Elsalam
Department of Tropical Medicine and Infectious Diseases, Tanta University, Tanta, Egypt.
Amal Saeid ALBendary
Clinical Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt.
Osama El. Sayed Negm
Department of Tropical Medicine and Infectious Diseases, Tanta University, Tanta, Egypt.
*Author to whom correspondence should be addressed.
Abstract
Background: All cirrhotic patients should be screened for oesophageal varices (OV) at the time of diagnosis. The development of a non-invasive method for the detection of OV is a vital issue in subjects with cirrhosis to decrease the need for invasive endoscopic procedures that can be costly. This work aimed to evaluate immature platelet fraction (IPF) as a non-invasive marker and predictor of OV.
Methods: This cross-sectional study was carried out on 80 cirrhotic patients with esophageal varices diagnosed by upper endoscopy. They were divided into Group (1): 40 patients with cirrhosis with esophageal varices and Group (2): 40 patients with cirrhosis and without esophageal varices. All patients were subjected to the complete history taking, physical examination, routine laboratory investigations (Complete blood count, IPF, C-reactive protein, Liver and kidney function tests, Bone marrow aspiration for some cases, Ascetic sample analysis when applicable), Pelvic-Abdominal ultrasonography, Child Pugh score assessment, Upper GIT endoscopy.
Results: There was a significant difference between the studied groups regarding IPF (p<0.001). At cutoff >12 IPF had (AUC= 0.993) with sensitivity of 97.5% and specificity of 97.5% for detection of esophageal varices. There was a significant negative correlation between IPF and platelets count (p- value < 0.001). There was a significant positive correlation between IPF and Child Pugh score (p- value <0.001). There was a highly significant positive correlation between IPF and CRP (p value <0.001). There was significant difference between the two groups as regards splenic longitudinal diameter (p<0.001). As regards platelet count, there was a significant difference between the two groups (p<0.001). It was significantly lower in Group 1.
Conclusions: IPF is elevated in cirrhotic patients with naive esophageal varices than in cirrhotic patients without varices. IPF could be used as a noninvasive, easy to measure method for detection of the presence of esophageal varices at a cutoff level of >12.
Keywords: Cirrhosis, immature platelet fraction, non-invasive assessment, esophageal varices.