Usefulness of Noninvasive Predictors of Oesophageal Varices in Black African Cirrhotic Patients in Côte d'Ivoire (West Africa)

Alassan Kouamé Mahassadi,Aboubacar Demba Bangoura,Mathieu Benoit Camara,Fulgence Yao Bathaix,Emile Allah-Kouadio,Stanislas Doffou,Abdoulaye Touré,Thérèse Aya Ndri-Yoman,Henriette Ya Kissi,Constant Assi,Issa Konaté,Alain Koffi Attia

doi:10.1155/2012/216390

Abstract

Aims. To determine the usefulness of platelet count (PC), spleen diameter (SD) and platelet count/spleen diameter ratio (PC/SD ratio) for the prediction of oesophageal varices (OV) and large OV in black African patients with cirrhosis in Côte d'Ivoire. Materials and Methods. Study was conducted in a training sample (111 patients) and in a validation sample (91 patients). Results. Factors predicting OV were sex: (OR = 0.08, P = 0.0003), PC (OR = 12.4, P = 0.0003), SD (OR = 1.04, P = 0.002) in the training sample. The AUROCs (±SE) of the model (cutoff ≥ 0.6), PC (cutoff < 110500), SD (cutoff > 140) and PC/SD ratio (cutoff ≤ 868) were, respectively; 0.879 ± 0.04, 0.768 ± 0.06, 0.679 ± 0.06, 0.793 ± 0.06. For the prediction of large OV, the model's AUROC (0.850 ± 0.05) was superior to that of PC (0.688 ± 0.06), SD (0.732 ± 0.05) and PC/SD ratio (0.752 ± 0.06). In the validation sample, with PC, PC/SD ratio and the model, upper digestive endoscopy could be obviated respectively in 45.1, 45.1, and 44% of cirrhotic patients. Prophylactic treatment with beta blockers could be started undoubtedly respectively in 36.3, 41.8 and 28.6% of them as having large OV. Conclusion. Non-invasive means could be used to monitor cirrhotic patients and consider treatment in African regions lacking endoscopic facilities.

Highlights

Oesophageal varices (OV) due to portal hypertension are a major concern in cirrhotic patients because of the risk of bleeding and related high mortality [1]
Cirrhosis was related to chronic hepatitis B, C, and alcohol consumption in 61.3%, 12.6%, and 20.7%, respectively
Post-hoc comparisons showed that platelet count (PC)/spleen diameter (SD) ratio was greater in cirrhotic patients with no OV than those with stage 2 (P < 0.0001) and stage 3 (P = 0.001) but quite similar to that of patients with stage 1 OV (P = 0.03, significance level sets at 0.01)

Summary

Introduction

Oesophageal varices (OV) due to portal hypertension are a major concern in cirrhotic patients because of the risk of bleeding and related high mortality [1]. The prevalence of OV in newly diagnosed cirrhotic patients is approximately 60–80% and the 1-year rate of first variceal bleeding is approximately 5% for small OV and 15% for large OV [1, 2]. For long-term followup, guidelines recommend monitoring of cirrhotic patients by routine endoscopy for the detection of the development of OV and to initiate prophylactic measures to prevent the bleeding of OV when they become large [3, 4]. It is obvious that in most African countries monitoring cirrhotic patients with endoscopy even at baseline or during followup is a challenge for clinicians due to the lack or not widely implemented and accessible endoscopy units [6]

Methods

Results

Conclusion