Correlation Between P2/MS Index and Portal Hypertension in Cirrhosis: A Prospective Study

Abstract

Background- Portal hypertension is a progressive complication of liver cirrhosis and it      is the cause of high morbidity and mortality. Prevalence of esophageal varices in patients with portal hypertension was 60-80% and incidence increasing by 5% per year with risk of bleeding by 25% -35%. Mortality rate in these patients is 20%-35% despite early diagnosis and treatment of variceal haemorrhage. Recently many studies have been conducted to use non-invasive methods to detect oesophageal varices in patient with cirrhosis of liver. One such method is P2/MS INDEX (Platelet count)²/ [monocyte fraction (%) - segmented neutrophil fraction (%)] of patients with cirrhosis of liver. P2/MS INDEX is a simple, accurate and non- invasive test for detecting varices in cirrhosis of patients.

Methodology- The study was conducted on 50 patients admitted with a diagnosis of cirrhosis of liver at general medicine and medical Gastroenterology wards of Saveetha Medical college, over the period of two years. Data was collected from all the patients who underwent detailed clinical evaluation, appropriate blood investigations, radiological studies (ultrasound with Doppler) and upper G.I endoscopy.

Results- Out of 50 patients, majority 18(36%) were in the age group 41-50. 27(54%) were Cirrhosis without PHT & 23(46%) were Cirrhosis with PHT. In patients with portal hypertension the median P²/MS index was 35 whereas in patients without portal hypertension the median P²/MS index was 114 which was statistically significant (p- value<0.001). Grade I varices in 7 patients with median P²/MS Index of 43, Grade II varices in 16 patients with median P²/MS Index of 35, Grade III varices in 8 patients with median P²/MS Index of 23.

Conclusion- Esophageal varices are more likely to be present in patients with a low p2/ms score, which has emerged as a strong predictor of the existence of esophageal varices in cirrhosis patients.