ABSTRACT
OBJECTIVE: To evaluate the predictive efficacy of the platelets-to-spleen diameter ratio (PSDR) for developing esophagogastric varices (EV) in patients with cirrhosis due to hepatitis B virus (HBV). METHODS: We conducted a retrospective cohort study using data from patients treated for HBV induced cirrhosis at Xi'an No. 3 Hospital, the Affiliated Hospital of Northwest University, from June 2020 to August 2023. Patients were categorized into two groups based on endoscopic evidence of EV: an EV group and a non-EV group. Clinical, sonographic, and hematological findings were compared within and between these groups. Stratified analyses based on the severity of varices were performed, and multivariate logistic regression was used to identify predictors of EV. Receiver Operating Characteristic (ROC) curve analysis assessed the diagnostic accuracy of PSDR in predicting EV. RESULTS: The study included 139 patients diagnosed with HBV induced cirrhosis, divided into an EV group (86 patients, with 48 low-risk and 38 high-risk) and a non-EV group (53 patients). Significant differences were found between the groups in several parameters: Child-Pugh classification, Child-Pugh score, portal vein diameter, hepatic vein deceleration index, spleen thickness, and PSDR (all P<0.001). These variables also varied significantly across the different risk categories within the EV group (all P<0.001). Multivariate logistic regression indicated PSDR as an independent predictor of EV development (Odds Ratio [OR]=3.569, 95% Confidence Interval [CI]: 0.970-1.001, P<0.001). ROC curve analysis showed that PSDR had an Area Under the Curve (AUC) of 0.865 (95% CI: 0.764-0.965) for predicting EV, with an optimal threshold of 1013.2, achieving 88.46% sensitivity and 69.23% specificity. For high-risk EV, PSDR showed an AUC of 0.763 (95% CI: 0.670-0.856), with a threshold of 883.5, sensitivity of 79.17%, and specificity of 54.17%. CONCLUSION: The PSDR is a significant risk marker and demonstrates strong predictive utility for both the presence and severity of EV in patients with HBV-induced cirrhosis. PSDR provides a valuable, non-invasive diagnostic tool for anticipating the development of EV in this patient population.