Evaluation of Platelet-albumin-bilirubin Score and its Relationship with Grading of Oesophageal Varices

Background: Oesophageal varices is one of the major complications seen in patients of liver cirrhosis with portal hypertension of various etiologies. Endoscopy is a gold standard procedure for its diagnosis but it is an invasive procedure. There are other modalities of non-invasive methods to determine the degree of varices and estimation of PALBI score is one among them. The aim of the study was to evaluate PALBI score and to see its relationship with grading of oesophageal varices.  Methods: This cross-sectional descriptive study was carried out from January, 2023 to December, 2023 in the Department of Medicine, Rajshahi Medical College Hospital, Rajshahi. The study was conducted on 96 patients suffering from oesophageal varices in cirrhosis of liver with portal hypertension. The blood sample was collected from median cubital vein and sent to the laboratory for estimation of albumin-bilirubin and platelet level using auto-analyzer machine. From albumin-bilirubin and platelet level, PALBI score was determined and related with oesophageal varices. Data were analyzed by SPSS software, version 24 and a p value < 0.05 was considered statistically significant for all tests. Results: The study revealed that out of 96 patients, the mean age of the patients was 48.35±14.75 years. Majority 65 (67.70%) of the patients were male and less than half 44 (45.80%) of the patients had class I-V level of education. PALBI score showed that 52 (54.20%), 26 (27.10%) and 18 (18.80%) of the patients were included in PALBI 3, PALBI 1 and PALBI 2 grade, respectively with mean PALBI score -2.12±0.75. Less than half 43 (44.80%) of the patients had moderate grade, 36 (37.50%) had severe grade and remaining 17 (17.70%) had mild grade of oesophageal varices. The relationship between PALBI score and grading of oesophageal varices in patients of liver cirrhosis with portal hypertension was found statistically highly significant (p < 0.001).  Conclusion: In rural and hard to reach areas where facilities for endoscopy were not readily available, platelet count can guide the physician in management and initiation of prophylactic therapy for esophageal varices. PALBI score is highly cost effective compared to endoscopy and hence can be considered as a screening tool for oesophageal varices.