Review question

What is the diagnostic accuracy of platelet count for the diagnosis of oesophageal varices in adults with liver disease or portal vein thrombosis?

Population

Adults with diagnosis of chronic liver disease or portal vein thrombosis. Age ≥ 18 years

Settings

Outpatients and inpatients in secondary/tertiary care setting

Study design

Prospective and retrospective cross‐sectional studies. No case‐control studies were found

Index tests

Platelet count

Reference standards

Upper endoscopy

Target condition

Summary accuracy (95% CI)

No. of participants (studies)

Prevalence,

Median

(range )

Implications in a hypothetical cohort of 1000 people

Post‐test probability

Quality and comments

Any varices

Cut‐off value: around 150,000 /mm³ (range 140,000 to 150,000/mm³)

Sensitivity 0.71 (0.63 to 0.77)

Specificity 0.80 (0.69 to 0.88)

LR+ 3.6
(2.4 to 5.4)

LR‐ 0.37
(0.30 to 0.45)

2054 participants (10)

38%
(25% to 79%)

With a prevalence of 38%, 380 out of 1000 people will have varices of any size. Of these 380 people, 110 (29% of 380) people with varices will receive misdiagnosis and will not received appropriate prophylaxis or follow‐up

The remaining 620 people will have no varices. 124 people (20% of 620) will receive false diagnosis of varices and will undergo an unnecessary endoscopy

Assuming a pretest probability of 38%

Post‐test probabilities:

• If test positive: 69%

• If test negative: 18%

Most studies are at high risk of bias

No predefinition of cut‐off value of the index test for most studies

Median prevalence of any varices is lower than that reported by most guidelines (around 50%)

.

High risk varices

Cut‐off value: around 150,000 /mm³ (range 140,000 to 160,000/mm³)

Sensitivity 0.80 (0.73 to 0.85)

Specificity 0.68 (0.57 to 0.77)

LR+ 2.5
(1.8 to 3.3)

LR‐ 0.30
(0.23 to 0.39)

1671 participants (7)

20%
(6% to 48%)

With a prevalence of 20%, 200 out of 1000 people will have varices at high risk of bleeding. Of these 200 people, 40 (20% of 200) people with high‐risk varices will receive misdiagnosis and will not receive effective prophylaxis

The remaining 800 people will not have high‐risk varices. 256 people (32% of 800) will receive false diagnosis of high‐risk varices and will undergo an unnecessary endoscopy

Assuming a pretest probability of 20%

Post‐test probabilities:

• If test positive: 38%

• If test negative: 7%

Most or all studies at high risk of bias

No predefinition of cut‐off value of the index test for most studies

Review question

What is the diagnostic accuracy of spleen length for the diagnosis of oesophageal varices in adult people with liver disease or portal vein thrombosis?

Population

Adults with diagnosis of chronic liver disease or portal vein thrombosis. Age ≥ 18 years

Settings

Outpatients and inpatients in secondary/tertiary care setting

Study design

Prospective and retrospective cross‐sectional studies. No case‐control studies were found

Index tests

Spleen length

Reference standards

Upper endoscopy

Target condition

Summary accuracy (95% CI)

No. of participants (studies)

Prevalence,

Median

(range )

Implications in a hypothetical cohort of 1000 people

Post‐test probability

Quality and comments

Any varices

Cut‐off value: around 110 mm (range 110 to 112.5 mm)

Sensitivity 0.85 (0.75 to 0.91)

Specificity 0.54 (0.46 to 0.62)

LR+ 1.8 (1.6 to 1.21)

LR‐ 0.28 (0.17 to 0.44)

594 participants (5)

53%
(17% to 71%)

With a prevalence of 53%, 530 out of 1000 people will have varices of any size. Of these 530 people, 80 (15% of 530) people with varices will receive misdiagnosis and will not receive appropriate prophylaxis or follow‐up

The remaining 470 people will have no varices. 216 people (46% of 470) will receive false diagnosis of varices and will undergo an unnecessary endoscopy

Assuming a pretest probability of 53%

Post‐test probabilities:

• If test positive: 67%

• If test negative: 24%

Most or all studies at high risk of bias

High‐risk varices

Cut‐off value: no common cut‐off value. Range 120 to 160 mm

Sensitivity ranged from 0.50 to 0.88 and specificity from 0.55 to 0.84

883 participants (6)

42%
(13% to 70%)

Inconsistency of results (no common cut‐off value) prevents any conclusions

.

Most or all studies at high risk of bias

What is the diagnostic accuracy of platelet count‐to‐spleen length ratio?

Review question

What is the diagnostic accuracy of platelet count‐to‐spleen length ratio for the diagnosis of oesophageal varices in adult people with liver disease or portal vein thrombosis?

Population

Adults with diagnosis of chronic liver disease or portal vein thrombosis. Age ≥ 18 years

Settings

Outpatients and inpatients in secondary/tertiary care setting

Study design

Prospective and retrospective cross‐sectional studies. No case‐control studies were found

Index tests

Platelet count‐to‐spleen length ratio

Reference standards

Upper endoscopy

Target condition

Summary accuracy
(95% CI)

No. of participants (studies)

Prevalence,

Median

(range )

Implications in a hypothetical cohort of 1000 people

Post‐test probability

Quality and comments

Any varices

Cut‐off value: 909 (n/mm³)/mm

Sensitivity 0.93 (0.93 to 0.87)

Specificity 0.84 (0.75 to 0.91)

LR+ 5.9
(3.5 to 9.9)

LR‐ 0.09
(0.03 to 0.22)

2637 participants (17)

58%
(38% to 75%)

With a prevalence of 58%, 580 out of 1000 people will have varices of any size. Of these 580 people, 41 (7% of 580) people with varices will receive misdiagnosis and will not receive appropriate prophylaxis or follow‐up

The remaining 420 people will have no varices. 67 people (16% of 420) will receive false diagnosis of varices and will undergo an unnecessary endoscopy

Assuming a pretest probability of 58%

Post‐test probabilities:

• If test positive: 89%

• If test negative: 10%

Most studies are at high risk of bias

High‐risk varices

Cut‐off value: around 909 (n/mm³)/mm (range 897 to 921 (n/mm³)/mm)

Sensitivity 0.85 (0.72 to 0.93)

Specificity 0.66 (0.52 to 0.77)

LR+ 2.5
(1.8 to 3.4)

LR‐ 0.22
(0.12 to 0.42)

642 participants (7)

60%
(18% to 70%)

With a prevalence of 60%, 600 out of 1000 people will have varices at high risk of bleeding. Of these 2600 people, 90 (15% of 600) people with high‐risk varices will receive misdiagnosis and will not receive effective prophylaxis

The remaining 400 people will not have high‐risk varices. 136 people (34% of 400) will receive false diagnosis of high‐risk varices and will undergo an unnecessary endoscopy

Assuming a pre‐test probability of 60%

Post‐test probabilities:

• If test positive: 79%

• If test negative: 25%

Most studies are at high risk of bias

Median prevalence of any varices is higher than that reported by most guidelines (around 25%)

What is the diagnostic accuracy of platelet count?

Review question

What is the diagnostic accuracy of platelet count for the diagnosis of oesophageal varices in paediatric people with liver disease or portal vein thrombosis?

Population

Children with diagnosis of chronic liver disease or portal vein thrombosis. Age < 18 years

Settings

Outpatients and inpatients in secondary/tertiary care setting

Study design

Prospective and retrospective cross‐sectional studies. No case‐control studies were found

Index tests

Platelet count

Reference standards

Upper endoscopy

Target condition

Summary accuracy
(95% CI)

No. of participants (studies)

Prevalence,

Median

(range )

Implications in a hypothetical cohort of 1000 people

Post‐test probability

Quality and comments

Any varices

Cut‐off value: around 120,000 /mm³ (range 115,000 to 119,000/mm³)

Sensitivity 0.71 (0.60 to 0.80)

Specificity 0.83 (0.70 to 0.91)

LR+ 4.2
(2.4 to 7.3)

LR‐ 0.35
(0.25 to 0.48)

277 participants (4)

58%
(48% to 69%)

With a prevalence of 58%, 580 out of 1000 children will have varices of any size. Of these 580 children, 168 (29% of 580) children with varices will receive misdiagnosis and will not receive appropriate. prophylaxis or follow‐up

The remaining 420 children will have no varices. 71 children (17% of 420) will receive false diagnosis of varices and will undergo an unnecessary endoscopy

Assuming a pretest probability of 58%

Post‐test probabilities:

• If test positive: 85%

• If test negative: 32.5%

Studies were at high risk of bias

What is the diagnostic accuracy of platelet count‐to‐spleen length ratio?

Review question

What is the diagnostic accuracy of platelet count‐to‐spleen length ratio for the diagnosis of oesophageal varices in paediatric people with liver disease or portal vein thrombosis?

Population

Children with diagnosis of chronic liver disease or portal vein thrombosis. Age < 18 years

Settings

Outpatients and inpatients in secondary/tertiary care setting

Study design

Prospective and retrospective cross‐sectional studies. No case‐control studies were found

Index tests

Platelet count‐to‐spleen length ratio

Reference standards

Upper endoscopy

Target condition

Summary accuracy (95% CI)

No. of participants (studies)

Prevalences

Implications in a hypothetical cohort of 1000 people

Post‐test probability

Quality and comments

Any varices

Cut‐off value: around 1000 (n/mm³)/mm

Sensitivity 0.74 (0.65 to 0.81)

Specificity 0.64 (0.36 to 0.85)

LR+ 2.0 (1.0 to 4.0)

LR‐ 0.41 (0.27 to 0.61)

197 participants
(2)

72% and 73%

With a prevalence of 50%, 500 out of 1000 children will have varices of any size. Of these 500 children, 130 (26% of 500) children with varices will receive misdiagnosis and will not receive appropriate prophylaxis or follow‐up

The remaining 500 children will have no varices. 180 children (36% of 500) will receive false diagnosis of varices and will undergo an unnecessary endoscopy

Assuming a pretest probability of 50%

Post‐test probabilities:

• If test positive: 67%

• If test negative: 29%

Limited evidence. Only 2 studies were found.

These 2 studies were at high risk of bias