P2988 - Gender-Specific Risk Stratification for Repeat Variceal Intervention: The Predictive Value of the Platelet Count/Spleen Diameter Ratio in Cirrhotic Patients

Sneh Parekh, DO¹, Anvit Reddy, DO², Yasasvhinie Santharam, DO¹, Nadim Qadir, DO², Gerardo Diaz Garcia, DO², Mohamed Elmasry, DO¹, Landen Burstiner, DO¹, Nirmal Onteddu, MD¹, Maged Ghali, MD¹
1University of Florida College of Medicine, Jacksonville, FL; 2University of Florida College of Medicine - 655 W 8th St Jacksonville, FL 32221UNITED STATES - Jacksonville, FL, Jacksonville, FL

Introduction: A life-threatening complication of gastroesophageal varices (GEV) is variceal bleeding, which occurs at a yearly rate of 5-15%, with about a 20% mortality rate. Traditionally, screening has been performed using esophagogastroduodenoscopy (EGD), as it is both diagnostic and therapeutic. A large cohort study demonstrated that a platelet count (PC) to spleen diameter (SD) ratio ≤ 1.36 independently predicts recurrent variceal bleeding in cirrhotic patients with moderate to severe GEV. This study aims to evaluate the impact of gender, race, and beta blocker use on the PC/SD ratio, and their association with repeat endoscopic interventions in patients with GEV.

Methods: We conducted a retrospective cohort study of adult patients with diagnosis codes of bleeding or non-bleeding GEV, who had follow-up EGDs, and had abdominal imaging capable of measuring SD, seen at the University of Florida Health in Jacksonville between 1/1/2014 and 1/31/2024. The PC to SD ratio was calculated as PC (N/mm3)/SD (mm), and repeat interventions were defined as endoscopic banding events on follow-up EGDs. Small varices were ≤ 5 mm or grade 1 on initial EGD, and large varices were > 5 mm, grade 2, or grade 3 on initial EGD. Patient characteristics are outlined in Table 1, with statistical analysis in Table 2. Statistical analysis was performed using either chi-square, Fisher's exact, or unpaired t-tests, with a significance threshold set at p < 0.05.

Results: Of 126 eligible patients, males had a significantly lower mean PC/SD ratio compared to females (0.893 ± 0.682 vs. 1.377 ± 1.327, p < 0.05) and underwent more repeat interventions (p < 0.05). Whites had a lower PC/SD ratio than blacks (0.921 ± 0.563 vs. 1.636 ± 1.896, p < 0.05), but this did not translate into more interventions. Beta blocker usage and initial variceal size were not associated with differences in the PC/SD ratio or intervention rates.

Discussion: A PC/SD ratio of ≤ 1.36 may help to identify patients at higher risk for bleeding events. The PC/SD ratio can be valuable in resource-limited settings or where endoscopic access is constrained, as it can help prioritize patients for endoscopic evaluation. Male patients with a low PC/SD ratio are at increased risk for repeat endoscopic interventions, suggesting a higher propensity for recurrent variceal bleeding. Limitations to the study include the retrospective design, small sample size, and data from a single-center. Prospective studies are needed and require further validation in diverse populations.


Figure: Table 1: Patient Characteristics


Figure: Table 2: Statistical Analysis of PC/SD Ratio of Various Demographic Factors

Disclosures:
Sneh Parekh indicated no relevant financial relationships.
Anvit Reddy indicated no relevant financial relationships.
Yasasvhinie Santharam indicated no relevant financial relationships.
Nadim Qadir indicated no relevant financial relationships.
Gerardo Diaz Garcia indicated no relevant financial relationships.
Mohamed Elmasry indicated no relevant financial relationships.
Landen Burstiner indicated no relevant financial relationships.
Nirmal Onteddu indicated no relevant financial relationships.
Maged Ghali indicated no relevant financial relationships.

Sneh Parekh, DO¹, Anvit Reddy, DO², Yasasvhinie Santharam, DO¹, Nadim Qadir, DO², Gerardo Diaz Garcia, DO², Mohamed Elmasry, DO¹, Landen Burstiner, DO¹, Nirmal Onteddu, MD¹, Maged Ghali, MD¹. P2988 - Gender-Specific Risk Stratification for Repeat Variceal Intervention: The Predictive Value of the Platelet Count/Spleen Diameter Ratio in Cirrhotic Patients, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.