Liver Transient Elastography Combined to Platelet Count (Baveno VI) Predict High Esophageal Varices in Black African Patient with Compensated Hepatitis B Related Cirrhosis

摘要

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.