Abstract / Summary
BackgroundOesophageal varices are a common complication of portal hypertension in cirrhosis, and upper gastrointestinal endoscopy remains the standard method for their detection and grading.The platelet count-to-spleen diameter (PC/SD) ratio is a simple non-invasive parameter that may help identify patients at increased risk of oesophageal varices. MethodsThis prospective observational study included 80 patients with cirrhosis and portal hypertension who were evaluated at Basaveshwar Teaching and General Hospital, Kalaburagi, Karnataka, between February 20, 2024, and August 20, 2025.PC, SD measured by ultrasonography, and the PC/SD ratio were assessed.All participants underwent upper gastrointestinal endoscopy for detection and grading of oesophageal varices.The association between PC/SD ratio and variceal presence and grade was evaluated, and receiver operating characteristic (ROC) curve analysis was performed. ResultsOesophageal varices were present in 42 (52.5%)patients, while 38 (47.5%) had no varices.Endoscopic grading showed Grade 1 varices in four (5.0%),Grade 2 in six (7.5%), and Grade 3 in 32 (40.0%) patients.The mean PC/SD ratio was significantly lower in patients with varices than in those without varices (809.51 ± 405.64 vs. 2,209.19± 1,479.72,p < 0.001).The mean PC/SD ratio progressively decreased with increasing variceal grade, from 2,209.19 in Grade 0 to 707.61 in Grade 3 (F = 11.887,p < 0.001).ROC analysis demonstrated an area under the curve of 0.893 (95% CI, 0.818-0.969;p < 0.001).A PC/SD ratio cut-off of <926 yielded a sensitivity of 89.5% and specificity of 69.0%. ConclusionThe PC/SD ratio was significantly associated with the presence and severity of oesophageal varices in patients with cirrhosis and portal hypertension.It may serve as a simple adjunctive screening and riskstratification tool to help prioritise patients for endoscopic evaluation.Larger multicentre studies are required to validate the study-specific cut-off and its broader clinical applicability.