الفهرس 
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Abstract
Portal hypertension is one of the most important complications of liver cirrhosis, leading to the development of oesophageal varices (OVs). Variceal bleeding carries high morbidity and mortality. The prevalence of varices among cirrhotic patients is variable, ranging from 24% to 80%, therefore, endoscopic screening of all patients with liver cirrhosis would result in a large number of unnecessary additional burdens to endoscopic units. Several studies have examined how to identify patients with varices using non-invasive or minimally invasive methods to avoid endoscopy in patients with low risk of varices. The present study was designed to evaluate PC/SD ratio and its possible association with varices in patients with liver cirrhosis. It included 100 patients collected from the outpatient clinic and internal ward of the Gastroenterology and Hepatology Unit, Tanta University Hospitals in the period between,” February 2021 to August 2021 ”. fulfilling the inclusion criteria, after getting the approval of the ethical committee. Cases were divided into two groups: group A: 63 cirrhotic patients with oesophageal varices. group B: 37 cirrhotic patients without oesophageal varices. The following patients were excluded from the study: 1. Active upper GIT bleeding 2. Hepatic encephalopathy 3. Patients are known to have OVs with previous endoscopy (either underwent band ligation or sclerotherapy). 4. Patients with a history of partial splenic embolization or splenectomy. 5. Patients with HCC. 6. Patients have TIPS. 7. Patients with PV thrombosis confirmed by US and color doppler study. 8. History of any liver surgery. 9. Patients on NSBBs. All cases were submitted to full history taking, thorough clinical examination, laboratory investigations, ultrasound examination, and upper GIT endoscopy. Finally, PC/SD ratio was determined and correlated with other variables. On the statistical analysis of data obtained from studied cases the following results were found: - In the present study, 100 cases with liver cirrhosis were included; the mean age was (56.37± 9.91) in patients with varices compared to (54.6 ± 6.35) in patients without varices. There was no statistically significant difference between groups (A and B) as regards age and gender. There was no statistically significant difference between the two studied groups as regards etiological factors of liver cirrhosis. However, HCV infection was the most common cause of liver cirrhosis in the studied patients. There was a statistically significant difference in jaundice, ascites, and lower limb edema which were prominent in group A (cirrhotic with varices). There was a statistically significant relation between low hemoglobin, low platelet count, and the presence of varices. There was no statistically significant difference between the two groups as regards alanine transaminase (ALT), and aspartate transaminase (AST). There was a negative relation between serum albumin level and esophageal varices which was statistically significant. There was a positive relation between bilirubin level and esophageal varices which was statistically significant. As regards coagulation profile there was a positive relation between INR level with varices presence which was statistically significant. As regards ultrasonographic findings, the portal vein diameter, spleen diameter, and ascites were statistically significantly higher in patients with varices compared with patients with no varices. Most cases with varices were Child class B and C, and most cases without varices were child class A. MELD, APRI, and FIB-4 scores were higher in patients with varices than in patients without varices. PC/SD ratio was significantly lower in patients with esophageal varices (mean±SD =681.83± 341.00) than patients without varices (mean±SD =1370.36 ± 452.61) and (P value<0.010). The following results were determined: PC/SD ratio: A cutoff value of (<987.28) could significantly predict OVs (AUROC=0.897) with sensitivity 83.80 %, specificity 81.0 %., PPV 72.10 %, NPV 89.50 %. And also, it correlated well with the degree of esophageal varices (AUROC= 0.688, 0.764, 0.795, 0.849) with a cutoff value of ( 784.37, 640.27, 597.50, 462.00 ) in grade I, II, III and IV respectively. MELD score: A cutoff value of (>13.69) could significantly predict OVs (AUROC=0.861) with sensitivity 74.60 %, specificity91.90 %., PPV 94.0%, NPV 68.0%. APRI score: A cutoff value of (>0.77) could significantly predict OVs (AUROC=0.766) with sensitivity 61.90%, specificity 94.60 %., PPV 95.10 %, NPV 59.30 %. FIB-4 score: A cutoff value of (>2.09) could significantly predict OVs (AUROC=0.810) with a sensitivity of 77.60%, specificity of 81.10%., PPV87.50 %, NPV 68.20%. On comparing these results, the following was concluded: The sensitivity: PC/SD ratio came with the highest sensitivity (83.80%), followed by the MELD score (74.60), followed by FIB-4 (77.60%), lastly APRI score and AST/ALT of the same sensitivity (61.90%). The specificity: APRI score had the highest specificity (94.60%), followed by MELD with a value (91.90 %), followed by FIB-4 (81.10%) which is close to that of PC/SD ratio (81.0%). AST/ALT score had the lowest value (59.90%) Positive predictive value (PPV): The highest PPV was that of APRI (95.10%), followed by MELD (94.0%), followed by FIB-4 (87.50%), and lastly came AST/ALT score and PC/SD score next with values (72.20%,72.10%) respectively. Negative predictive value (NPV): PC/SD ratio was the best negative predictor (89.50%) followed by FIB-4 (68.20%), then came MELD (68.0%) followed by APRI score (59.30%), and lastly AST/ALT score (47.80%). The area under the curve (AUC): The highest value was that of PC/SD (0.897) then came the MELD score (0.861), FIB-4 (0.810), APRI score (0.766), and lastly AST/ALT score (0.647).