S1271 Gender-Specific Risk Stratification for Repeat Variceal Intervention: The Predictive Value of the Platelet Count/Spleen Diameter Ratio in Cirrhotic Patients

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. 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. Conclusion: 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.