Use of Liver Stiffness–Platelet Count–Spleen Size Score to predict the presence of Esophageal Varices and their grade in Patients of Liver Cirrhosis
Abstract
Background: Portal hypertension is a major consequence of liver cirrhosis and leads to the development of esophageal varices, whichare associated with significant morbidity and mortality. Upper gastrointestinal endoscopy (UGIE) remains the gold standard for diagnosis;however, it is invasive, costly, and not universally accessible. Non-invasive predictors such as the liver stiffness–platelet count–spleensize score (LSPS) have emerged as promising alternatives for predicting esophageal varices. Objectives: To evaluate the correlation between LSPS and the grading of esophageal varices in patients with liver cirrhosis and to assessthe utility of LSPS as a non-invasive tool for risk stratification. Methods: This cross-sectional observational study was conducted in the Department of Medicine, Government Medical College and Rajindra Hospital, Patiala. One hundred adult patients with liver cirrhosis confirmed clinically, biochemically, radiologically, and bytransient elastography (FibroScan® liver stiffness measurement ≥12.5 kPa) were included. Liver stiffness measurement, spleen bipolardiameter, platelet count, and upper gastrointestinal endoscopy findings were recorded. LSPS was calculated using the formula: liverstiffness (kPa) × spleen diameter (cm) / platelet count (×10⁹/L). Statistical analysis included chi-square test, t-test, and ANOVA. Results: The mean age of participants was 49.4 ± 13.4 years, with male predominance (68%). Alcohol-related cirrhosis was the mostcommon etiology (32%), followed by hepatitis C infection and metabolic associated steatohepatitis (20% each). Esophageal variceswere present in 52% of patients, including Grade 1 varices in 32%, Grade 2 in 12%, and Grade 3 in 8%. High-risk varices were identified in20% of patients. Mean LSPS among study participants was 1.72 ± 1.43. Patients with higher grades of esophageal varices demonstratedsignificantly elevated LSPS values. LSPS showed a positive correlation with variceal grade and effectively identified patients with highriskvarices. Conclusion: LSPS is a simple, reliable, and non-invasive predictor of esophageal varices and correlates positively with variceal severityin cirrhotic patients. It may serve as a useful screening and risk stratification tool, especially in resource-limited settings, potentiallyreducing unnecessary endoscopic procedures.
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