%0 Journal Article
%T Usefulness of Noninvasive Predictors of Oesophageal Varices in Black African Cirrhotic Patients in C£¿te d'Ivoire (West Africa)
%A Alassan Kouam¨¦ Mahassadi
%A Fulgence Yao Bathaix
%A Constant Assi
%A Aboubacar Demba Bangoura
%A Emile Allah-Kouadio
%A Henriette Ya Kissi
%A Abdoulaye Tour¨¦
%A Stanislas Doffou
%A Issa Konat¨¦
%A Alain Koffi Attia
%A Mathieu Benoit Camara
%A Th¨¦r¨¨se Aya Ndri-Yoman
%J Gastroenterology Research and Practice
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/216390
%X 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 C£¿te 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: ( , ), PC (OR = 12.4, ), SD (OR = 1.04, ) in the training sample. The AUROCs (¡ÀSE) of the model (cutoff ¡Ý 0.6), PC (cutoff < 110500), SD (cutoff > 140) and PC/SD ratio (cutoff ¡Ü 868) were, respectively; 0.879 ¡À 0.04, 0.768 ¡À 0.06, 0.679 ¡À 0.06, 0.793 ¡À 0.06. For the prediction of large OV, the model¡¯s AUROC (0.850 ¡À 0.05) was superior to that of PC (0.688 ¡À 0.06), SD (0.732 ¡À 0.05) and PC/SD ratio (0.752 ¡À 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. 1. 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¨C80% and the 1-year rate of first variceal bleeding is approximately 5% for small OV and 15% for large OV [1, 2]. The determination of the presence of OV by upper digestive endoscopy is therefore mandatory in patients with cirrhosis at diagnosis [3]. 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]. Endoscopy is however a costly, invasive, and time-consuming procedure [5]. 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]. Several studies have reported that platelet count (PC), spleen diameter (SD) and their ratio (PC/SD), portal vein diameter, and Child-Pugh score were strongly associated with the presence of OV in cirrhotic patients [7¨C10]. Predictive models derived from these
%U http://www.hindawi.com/journals/grp/2012/216390/