Liver Transient Elastography Combined to Platelet Count (Baveno VI) Predict High Esophageal Varices in Black African Patient with Compensated Hepatitis B Related Cirrhosis
Aim: To assess the predictive value of the Baveno VI criteria for the diagnosis of large esophageal varices (EV) in Black African patient with compensated hepatitis B related cirrhosis. Methods: We carried out a cross-sectional study from January 2 to July 3 (2016), in Department of Gastroenterology at University Hospitals of Cocody (CHUC) and Yopougon (CHUY). All the black African patients included were more than 15 years old and their liver elasticity score (LES) was carried out at Yopougon University Hospital. Hepatitis B related cirrhosis was defined by LES ≥ 11 kPa (FibroScan？ (Echosens, France)) with positive HBs antigen (HBsAg) and anti HBc antibody. All the patients with hepatitis B related cirrhosis performed a gastroscopy at Cocody University Hospital and esophageal varices were ranked according to société fran？aise d’endoscopie digestive (SFED) classification. Data analysis was performed by SPSS model 20.0 statistics software (SPSS Inc., Chicago, IL, United States). Diagnostic performance of LES < 20 kPa and platelet count > 150,000/mmm3 (Baveno VI criteria) for the diagnosis of large EV by gastroscopy was studied (area under the ROC curve, specificity (Sp), sensitivity (Se), positive predictive value (PPV) and negative predictive value (NPV). Results: During the study period, 720 patients achieved liver FibroScan？ at CHUY. Of these, 60 respondents to our inclusion criteria were prospectively included in our study. Twelve (20%) of these 60 patients met the Baveno VI criteria. EV were present in 40% of cases (n = 24) with 6.7% (n = 4), 15% (n = 9) and 18.3% (n = 11) of grade 1, 2 and 3, respectively. (66.7% (n = 40) without EV or with small EV) and 33.3% (n = 20) with large EV. The Baveno VI criteria had a Se, Sp, PPV and NPV of 100%, 41.6%, 30% and 100% respectively for the diagnosis of large EV. The area under the ROC curve of a platelet count greater than 150,000/mm3, a liver elasticity score of less than 20 kPa and combination of both were respectively 0.763 [0.645 - 0.880; P = 0.272]; 0.588 [0.436 - 0.739; P = 0.01] and 0.650 [0.513 - 0.787 P = 0.005]. Conclusion: The combination of liver elasticity score < 20 kPa and a blood platelet count > 150,000/mm3, allowed the exclusion of large esophageal varices at gastroscopy with a 100 % NPV in Black African patients with compensated hepatitis B related cirrhosis.
References
[1]
Cabrera, L., Tandon, P. and Abraldes, J.G. (2016) An Update on the Management of Acute Esophageal Variceal Bleeding. Gastroenterologia y Hepatologia, 40, 34-40.
[2]
Zaman, A. (2003) Current Management of Esophageal Varices. Current Treatment Options in Gastroenterology, 6, 499-507.
https://doi.org/10.1007/s11938-003-0052-3
[3]
Bouglouga, O., Bagny, A., Lawson-Ananissoh, L. and Djibril, M. (2014) Hospital Mortality Associated with Upper Gastrointestinal Hemorrhage Due to Ruptured Esophageal Varices at the Lome Campus Hospital in Togo. Medecine et Sante Tropicales, 24, 388-391.
[4]
Elalfy, H., Elsherbiny, W., Abdel Rahman, A., Elhammady, D., Shaltout, S.W., Elsamanoudy, A.Z. and El Deek, B. (2016) Diagnostic Non-Invasive Model of Large Risky Esophageal Varices in Cirrhotic Hepatitis C Virus Patients. World Journal of Hepatology, 8, 1028-1037. https://doi.org/10.4254/wjh.v8.i24.1028
[5]
Mahassadi, A.K., Bathaix, F.Y., Assi, C., Bangoura, A.D., Allah-Kouadio, E., Kissi, H.Y., Touré, A., Doffou, S., Konaté, I., Attia, A.K., Camara, M.B. and Ndri-Yoman, T.A. (2012) Usefulness of Noninvasive Predictors of Oesophageal Varices in Black African Cirrhotic Patients in Côte d'Ivoire (West Africa). Gastroenterology Research and Practice, 2012, 216390. https://doi.org/10.1155/2012/216390
[6]
Abraldes, J.G., Bureau, C., Stefanescu, H., Augustin, S., Ney, M., Blasco, H., Procopet, B., Bosch, J., Genesca, J., Berzigotti, A. and Anticipate Investigators (2016) Noninvasive Tools and Risk of Clinically Significant Portal Hypertension and Varices in Compensated Cirrhosis: The “Anticipate” Study. Hepatology, 64, 2173-2184. https://doi.org/10.1002/hep.28824
[7]
de Franchis, R. and Dell’Era, A. (2014) Invasive and Noninvasive Methods to Diagnose Portal Hypertension and Esophageal Varices. Clinical Liver Disease, 18, 293-302.
[8]
European Association for Study of Liver (2015) Asociacion Latinoamericana para el Estudio del Higado. EASL-ALEH Clinical Practice Guidelines: Non-Invasive Tests for Evaluation of Liver Disease Severity and Prognosis. Journal of Hepatology, 63, 237-264.
[9]
Nada, L., Samira el, F., Bahija, B., Adil, I. and Nourdine, A. (2015) Noninvasive Predictors of Presence and Grade of Esophageal Varices in Viral Cirrhotic Patients. The Pan African Medical Journal, 20, 145.
https://doi.org/10.11604/pamj.2015.20.145.4320
[10]
Castera, L. (2007) Use of Elastometry (FibroScan) for the Non-Invasive Staging of Liver Fibrosis. Gastroenterologie Clinique Et Biologique, 31, 524-530; quiz 500, 531-532.
[11]
Shi, K.Q., Fan, Y.C., Pan, Z.Z., Lin, X.F., Liu, W.Y., Chen, Y.P. and Zheng, M.H. (2013) Transient Elastography: A Metaanalysis of Diagnostic Accuracy in Evaluation of Portal Hypertension in Chronic Liver Disease. Liver International, 33, 6271.
[12]
De Franchis, R. and Baveno VI Faculty Collaborators (2015) Expanding Consensus in Portal Hypertension: Report of the Baveno VI Consensus Workshop: Stratifying Risk and Individualizing Care for Portal Hypertension. Journal of Hepatology, 63, 743-752. https://doi.org/10.1016/j.jhep.2015.05.022
[13]
Cardenas, A. and Mendez-Bocanegra, A. (2016) Report of the Baveno VI Consensus Workshop. Annals of Hepatology, 15, 289-290.
[14]
Augustin, S., Pons, M. and Genesca, J. (2016) Validating the Baveno VI Recommendations for Screening Varices. Journal of Hepatology, 66, 459-460.
https://doi.org/10.1016/j.jhep.2016.09.027
[15]
Maurice, J.B., Brodkin, E., Arnold, F., Navaratnam, A., Paine, H., Khawar, S., Dhar, A., Patch, D., O’Beirne, J., Mookerjee, R., Pinzani, M., Tsochatzis, E. and Westbrook, R.H. (2016) Validation of the Baveno VI Criteria to Identify Low Risk Cirrhotic Patients Not Requiring Endoscopic Surveillance for Varices. Journal of Hepatology, 65, 899-905. https://doi.org/10.1016/j.jhep.2016.06.021
[16]
Berzigotti, A., Boyer, T.D., Castéra, L., de Franchis, R., Genescà, J. and Pinzani, M. (2015) Reply to “Points to Be Considered When Using Transient Elastography for Diagnosis of Portal Hypertension According to the Baveno’s VI Consensus. Journal of Hepatology, 63, 1049-1050. https://doi.org/10.1016/j.jhep.2015.07.012
[17]
Perazzo, H., Fernandes, F.F., Castro Filho, E.C. and Perez, R.M. (2015) Points to Be Considered When Using Transient Elastography for Diagnosis of Portal Hypertension According to the Baveno’s VI Consensus. Journal of Hepatology, 63, 1048-1049.
[18]
Bonnard, P., Sombie, R., Lescure, F.X., Bougouma, A., Guiard-Schmid, J.B., Poynard, T., Cales, P., Housset, C., Callard, P., Le Pendeven, C., Drabo, J., Carrat, F. and Pialoux, G. (2010) Comparison of Elastography, Serum Marker Scores, and Histology for the Assessment of Liver Fibrosis in Hepatitis B Virus (HBV)-Infected Patients in Burkina Faso. The American Journal of Tropical Medicine and Hygiene, 82, 454-458. https://doi.org/10.4269/ajtmh.2010.09-0088
[19]
Pugh, R.N., Murray-Lyon, I.M., Dawson, J.L., Pietroni, M.C. and Williams, R. (1973) Transection of the Oesophagus for Bleeding Oesophageal Varices and Performed Ultrasound for Each Patient (Size of the Spleen, Splenomegaly If the Diameter of the Spleen >130 mm) and Possible Presence of an Ascite. British Journal of Surgery, 60, 646-649.
[20]
Lebrec, D., Vinel, J.P. and Dupas, J.L. (2005) Complications of Portal Hypertension in Adults: A French Consensus. European Journal of Gastroenterology & Hepatology, 17, 403-410. https://doi.org/10.1097/00042737-200504000-00003
[21]
Abd-Elsalam, S., Habba, E., Elkhalawany, W., Tawfeek, S., Elbatea, H., El-Kalla, F., Soliman, H., Soliman, S., Yousef, M., Kobtan, A., El Nawasany, S., Awny, S., Amer, I., Mansour, L. and Rizk, F. (2016) Correlation of Platelets Count with Endoscopic Findings in a Cohort of Egyptian Patients with Liver Cirrhosis. Medicine (Baltimore), 95, e3853.
[22]
Hua, J., Liu, G.Q., Bao, H., Sheng, L., Guo, C.J., Li, H., Ma, X. and Shen, J.L. (2015) The Role of Liver Stiffness Measurement in the Evaluation of Liver Function and Esophageal Varices in Cirrhotic Patients. Journal of Digestive Diseases, 16, 98-103.
[23]
Sharma, P., Kirnake, V., Tyagi, P., Bansal, N., Singla, V., Kumar, A. and Arora, A. (2013) Spleen Stiffness in Patients with Cirrhosis in Predicting Esophageal Varices. The American Journal of Gastroenterology, 108, 1101-1107.
https://doi.org/10.1038/ajg.2013.119
[24]
Ding, N.S., Nguyen, T., Iser, D.M., Hong, T., Flanagan, E., Wong, A., Luiz, L., Tan, J.Y., Fulforth, J., Holmes, J., Ryan, M., Bell, S.J., Desmond, P.V., Roberts, S.K., Lubel, J., Kemp, W. and Thompson, A.J. (2016) Liver Stiffness plus Platelet Count Can Be Used to Exclude Highrisk Oesophageal Varices. Liver International, 36, 240-245.
https://doi.org/10.1111/liv.12916
[25]
Augustin, S., Millán, L., González, A., Martell, M., Gelabert, A., Segarra, A., Serres, X., Esteban, R. and Genescà (2014) Detection of Early Portal Hypertension with Routine Data and Liver Stiffness in Patients with Asymptomatic Liver Disease: A Prospective Study. Journal of Hepatology, 60, 561-569.
https://doi.org/10.1016/j.jhep.2013.10.027
[26]
Pritchett, S., Cardenas, A., Manning, D., Curry, M. and Afdhal, N.H. (2011) The Optimal Cutoff for Predicting Large Oesophageal Varices Using Transient Elastography Is Disease Specific. Journal of Viral Hepatitis, 18, e7580.
