Predictive Values of Platelets Count and Spleen Diameter in the Diagnosis of Esophageal Varices in Black African Cirrhotic Patients

Background: Gastrointestinal hemorrhage from ruptured esophageal varices is of concern in Africa where gastrointestinal fibroscopy for diagnosis is lacking. Purpose: To determine the performance of the length of the spleen, of the platelet count in the diagnosis of esophageal varices (OVs) by specifying the diagnostic thresholds in order to facilitate the prophylaxis of varicose hemorrhages in black African cirrhotic patients. Material and Method: This was a prospective study with a descriptive and analytical aim on cirrhotic patients hospitalized at the university hospital of Bouake (Ivory Coast) from 2017 to 2019. The patients included in the study were the cirrhotic of black race hospitalized having carried out an abdominal ultrasound with measurement of the spleen diameter (SD), an eso-gastro-duodenal endoscopy, and a blood count with platelet count (PC). The first primary endpoint was the diagnosis of esophageal varices in cirrhosis. Cirrhosis was retained by the combination of clinical, biological, ultrasound and endoscopic arguments. The OVs were distributed according to size and the presence of red signs. The platelet count, and the measurement of the spleen to calculate the PC/SD ratio were the second endpoint. The secondary endpoints studied were, the viral and ethyl etiologies of the cirrhosis, the Chlid-Pugh prognostic score. Performance was assessed using the ROC curve. The difference was significant for p less than 0.05. Results: The study included 101 patients;they were 79 men (78.2%) and 22 women (21.8%). The mean age of the cirrhotic patients was 48 ± 14. Esophageal varices were present in (n = 93;92%) of cases. The different etiologies were hepatitis B virus (HBV) (n = 65;78.3%), hepatitis C virus (HCV) (n = 21;25, 3%), and alcohol (n = 6;7.2%). Platelet count (PC) < 100,000/mm3 was statistically related to the presence of OV with red signs. Splenomegaly (SD > 130 mm) and PC/SD ratio < 1000 were significantly related to the presence of OVs and large OVs. SD with a cutoff of > 102 mm predicted 75% of OVs (AUROC = 0.797). CP with a cutoff < 131,000/mm3, predicted 100% of OVs (AUROC = 0.756). The PC/SD ratio < 1205 diagnosed 100% of OV (AUROC = 0.801). The PC/SD ratio < 818 and SD > 129 mm predicted large OVs. Conclusion: Platelet count, spleen diamater, and PC/SD ratio were all performant for the diagnosis of OVs in our setting with better diagnostic performance for PC/SD. This report could help initiate prophylactic treatment for OVs rupture in cirrhotic patients in health centers where gastrointestinal endoscopy is lacking.

Mortality Factors for Cirrhotics in an Ivorian University Hospital (Ivory Coast)

Background: Cirrhosis, an ineluctable development of chronic liver disease, still has high mortality throughout the world despite many advances in physiopathology and therapy. This high mortality is closely related to the unpredictable course of cirrhosis with numerous complications. Objective: To evaluate the predictive factors of death during cirrhosis. Materials and methods: This is an observational, descriptive study on cirrhotic patients hospitalized in the hepatology unit of the Center Hospitalier Universitaire in Bouake (Ivory Coast) during the period from January 01, 2018 to December 31, 2019. The study focused on the data collected in the medical files (paper format) of hospitalized cirrhotics and the death register of the service. The diagnosis of cirrhosis and the death of the cirrhotic were the main criteria for judgment. The secondary criteria defined were: history of cirrhosis, reasons for consultation, clinical signs, biological signs, complications of cirrhosis and the treatment received. The relationship between the parameters was expressed as an odds ratio (OR) with a 95% confidence interval (CI) and the significance threshold fixed at p < 0.05. Results: The study retained 206 files of cirrhotics including 146 men and 60 women. The hospital prevalence of cirrhosis was 44.17% and the mortality rate was 42.23%. The deceased patients were mainly men with an average age of 49 years. The etiologies of cirrhosis were dominated by viral hepatitis B, chronic alcohol poisoning and viral hepatitis C, respectively 46.95%, 37.35% and 10.84%. The predictors of death were: the presence of icterus (OR = 1.89, 95%CI [1.08 - 3.30], p = 0.036), hepatic encephalopathy (OR = 8.75, 95%CI [4.51 - 16.94], p < 0.001) and hepatocellular carcinoma (OR = 2.23, 95%CI [1.25 - 3.98], p = 0.010);the presence in the biology of hepatic cytolysis (OR = 2.57, 95%CI [1.35 - 4.89], p = 0.006), severe hepatocellular insufficiency (OR = 2.57, 95%CI [1.38 - 4.77], p = 0.004), severe renal insufficiency (OR = 2.41, 95%CI [1.09 - 5.32], p = 0.044) and hyperleukocytosis (OR = 2.28, 95%CI [1.29 - 4.04], p = 0.007);Child-Pugh stage C (OR = 19.64, 95%CI [9.02 - 42.74], p < 0.001);the presence on ultrasound of large liver and variable nodules (OR = 4.16, 95%CI [2.02 - 8.58], p < 0.001). Conclusion: Cirrhosis is a public health problem at the Bouake university hospiler center. Decompensated and complicated old cirrhosis, hepatic cytolysis, severe hepatocellular insufficiency, severe renal insufficiency and hyperleukocytosis, heterogeneous nodular large liver are the detrimental factors.

Factors Associated with the Applicability of EPAGE (European Panel on the Appropriateness of Gastrointestinal Endoscopy) and the Suitability of Indications for Eso-Gastroduodenal Endoscopy in a West African Country

Background: EGDF’s reference examination for exploring the digestive tract has seen steadily increasing demands over the past few years. The exam can be expensive and often poorly tolerated. Its prescription must take the cost/be- nefit and its relevance into account. The EPAGE criteria were developed to allow the appropriate selection of endoscopic procedures. Objective: To determine the factors associated with the applicability and appropriateness of the EGDF indications by the EPAGE criteria in our context in order to limit the number of inadequate EGDFs. Material and Method: Prospective cross- sectional study on the applicability of EPAGE (European Panel on the Appropriateness of Gastrointestinal Endoscopy) and the relevance of the indications for Eso-Gastro-Duodenal Fibroscopy (EGDF) according to the criteria of the EPAGE in two large public hospitals located in the central region of Ivory Coast over a period of 8 months from September 2019 to May 2020. The following parameters (age, sex, history and comorbidities of the patient, the indication of EGDF, the qualification of the prescriber, the EPAGE situation, the relevance of the indications according to EPAGE, the result of the EGDF) were collated classified into judgment criteria and analyzed via the site https://www.epage.ch/ depending on whether the indication was appropriate, uncertain or inappropriate. The difference was significant for a value of p ≤ 0.05. Results: This was 1010 EGDF. The indications for EGDF were epigastralgia, gastrointestinal haemorrhage, testing for PHT signs, heartburn, vomiting, dysphagia, chest pain, anemia, control, tumor assessment. The result of EGDF was normal (14.9%), non-significant lesions (47.5%) and significant lesions (37.6%). EPAGE was applicable in 93.8% of patients, and the indications for EGDF were considered appropriate in 54.2% of cases. The EPAGE criteria were significantly applicable and appropriate in cases of epigastralgia, digestive haemorrhage, heartburn, and vomiting but not applicable for the search for signs of PH, for non-significant lesions and for 1/3 of gastric cancer. Significant lesions predominated in patients with appropriate indications (p < 0.001), whereas some significant lesions had uncertain indications. Conclusion: In our context, the EPAGE criteria could constitute a useful tool for the diagnostic profitability of EGDF. The indications deemed appropriate are statically associated with significant lesions and advanced age. But EPAGE must be adapted to our indications and cannot replace the reasoning of the practitioner when faced with the suspicion of significant lesions.