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Abstract
RÉSUMÉ
OBJECTIFS. Identifier des paramètres cliniques et para cliniques pour l’approche non endoscopique du diagnostic des varices œsophagiennes chez les patients atteints de cirrhose, en contexte sub-saharien.
MATÉRIELS ET MÉTHODES. Les dossiers de patients cirrhotiques camerounais examinés au Centre Hospitalier et Universitaire de Yaoundé entre mars 2013 et novembre 2014 ont été revus. Les données cliniques, biologiques, échographiques et ont été analysées et comparées à la sévérité des varices œsophagiennes retrouvées par endoscopie. La méthode de classification et régression par carte a permis de construire un arbre de prédiction des varices œsophagiennes.
RÉSULTATS. Nous avons inclus 98 patients cirrhotiques d’âge compris entre 14 et 80 ans. Les hépatites virales B et C ont été retrouvées chez 78 patients (79,59%). 53 patients (54,08%) étaient classés Child-Pugh C. La prévalence des varices œsophagiennes était de 92% (90/98) avec 63,27% de grade III. Les variables indépendamment associés à la sévérité des varices œsophagiennes étaient les taux de prothrombine, d’hémoglobine, d’albumine, de leucocytes, de créatinine sérique et la taille de la rate. Ces facteurs ont été utilisés pour construire un arbre de prédiction de survenue des VO.
CONCLUSION. A l’aide d’un arbre décisionnel intégrant la taille de la rate et cinq facteurs biologiques, il est possible de prédire la sévérité des varices œsophagiennes post-cirrhotiques en contexte sub-saharien.
SUMMARY
OBJECTIVES. To identify some clinical and para clinical parameters for non-endoscopic screening of esophageal varices in patients with liver cirrhosis, in sub-Saharan setting.
MATERIALS AND METHODS. The medical records of black African Cameroonian cirrhotic patients received between March 2013 and November 2014 in the University Teaching Hospital of Yaounde were reviewed. Clinical, biological and sonographic findings were analyzed and compared to the severity of endoscopically diagnosed esophageal varices. The classification and regression tree method was used to build a prediction tree of esophageal varices.
RESULTS. We studied 98 cirrhotic patients aged 14-80 years. Viral hepatitis B and C were found in 78 (79.59%) patients. Cirrhosis was graded Child-Pugh C in 53 patients (54.08%). The prevalence of esophageal varices was 92% (90/98) with 63.27% of grade III. The factors independently associated with the severity of esophageal varices were prothrombin time, hemoglobin level, albumin, leukocytes, serum creatinin level and the size of the spleen. We used these factors to build a predictive tree for esophageal varices.
CONCLUSION. A prediction tree including the spleen size and five biological factors could help to predict the severity of post-cirrhotic esophageal varices in sub-Saharan setting without systematic use of endoscopy.
Article Details
References
- Schepis F, Cammà C, Niceforo D, Magnano A, Pallio S, Cinquegrani M, et al. Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection? Hepatol Baltim Md. 2001 Feb;33(2):333–8.
- Madhotra R, Mulcahy HE, Willner I, Reuben A. Prediction of Esophageal Varices in Patients With Cirrhosis. J Clin Gastroenterol [Internet]. 2002;34(1). Available from: http://journals.lww.com/jcge/Fulltext/2002/01000/Prediction_of_Esophageal_Varices_in_Patients_With.16.aspx
- Gorka W, al Mulla A, al Sebayel M, Altraif I, Gorka TS. Qualitative hepatic venous Doppler sonography versus portal flowmetry in predicting the severity of esophageal varices in hepatitis C cirrhosis. Am J Roentgenol. 1997 Aug 1;169(2):511–5.
- Chang MH, Sohn JH, Kim TY, Son BK, Kim JP, Jeon YC, et al. [Non-endoscopic predictors of large esophageal varices in patients with liver cirrhosis]. Korean J Gastroenterol Taehan Sohwagi Hakhoe Chi. 2007 Jun;49(6):376–83.
- Schwarzenberger E, Meyer T, Golla V, Sahdala NP, Min AD. Utilization of platelet count spleen diameter ratio in predicting the presence of esophageal varices in patients with cirrhosis. J Clin Gastroenterol. 2010 Feb;44(2):146–50.
- Attia KA, N’dri-Yoman T, Talla P, Bathaix Y, Mahassadi A, Kissi H, et al. Facteurs prédictifs des signes endoscopiques d’hypertension portale sévère chez le cirrhotique en milieu africain : Etude de 131 cas. Médecine Afr Noire. 2003;50(3):109–14.
- Hong W, Dong L, Jiang Z, Zhu Q, Jin S. Prediction of large esophageal varices in cirrhotic patients using classification and regression tree analysis. Clin São Paulo Braz. 2011;66(1):119–24.
- Florent C, Meary N, Abdini E, Mostefa-Kara N. Histoire naturelle des varices œsophagiennes. Acta Endosc. 1995 Jul;25(4):319–26.
- Kishimoto R, Chen M, Ogawa H, Wakabayashi MN, Kogutt MS. Esophageal varices: evaluation with transabdominal US. Radiology. 1998 Mar;206(3):647–50.
- Sharma SK, Aggarwal R. Prediction of large esophageal varices in patients with cirrhosis of the liver using clinical, laboratory and imaging parameters. J Gastroenterol Hepatol. 2007 Nov;22(11):1909–15.
- Augustin S, Muntaner L, Altamirano JT, González A, Saperas E, Dot J, et al. Predicting early mortality after acute variceal hemorrhage based on classification and regression tree analysis. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2009 Dec;7(12):1347–54.
- Chiaramonte M, Stroffolini T, Ngatchu T, Rapicetta M, Lantum D, Kaptue L, et al. Hepatitis B virus infection in Cameroon: a seroepidemiological survey in city school children. J Med Virol. 1991 Feb;33(2):95–9.
- Mbanya DN, Takam D, Ndumbe PM. Serological findings amongst first-time blood donors in Yaoundé, Cameroon: is safe donation a reality or a myth? Transfus Med Oxf Engl. 2003 Oct;13(5):267–73.
- Zaman A, Hapke R, Flora K, Rosen HR, Benner K. Factors predicting the presence of esophageal or gastric varices in patients with advanced liver disease. Am J Gastroenterol. 1999 Nov;94(11):3292–6.
- Pilette C, Oberti F, Aubé C, Rousselet MC, Bedossa P, Gallois Y, et al. Non-invasive diagnosis of esophageal varices in chronic liver diseases. J Hepatol. 1999 Nov;31(5):867–73.
- Chalasani N, Imperiale TF, Ismail A, Sood G, Carey M, Wilcox CM, et al. Predictors of large esophageal varices in patients with cirrhosis. Am J Gastroenterol. 1999 Nov;94(11):3285–91.
- Nakano R, Iwao T, Oho K, Toyonaga A, Tanikawa K. Splanchnic hemodynamic pattern and liver function in patients with cirrhosis and esophageal or gastric varices. Am J Gastroenterol. 1997 Nov;92(11):2085–9.
- Liu C-H, Hsu S-J, Liang C-C, Tsai F-C, Lin J-W, Liu C-J, et al. Esophageal varices: noninvasive diagnosis with duplex Doppler US in patients with compensated cirrhosis. Radiology. 2008 Jul;248(1):132–9.
- D’Amico G, Morabito A. Noninvasive markers of esophageal varices: another round, not the last. Hepatol Baltim Md. 2004 Jan;39(1):30–4.
References
Schepis F, Cammà C, Niceforo D, Magnano A, Pallio S, Cinquegrani M, et al. Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection? Hepatol Baltim Md. 2001 Feb;33(2):333–8.
Madhotra R, Mulcahy HE, Willner I, Reuben A. Prediction of Esophageal Varices in Patients With Cirrhosis. J Clin Gastroenterol [Internet]. 2002;34(1). Available from: http://journals.lww.com/jcge/Fulltext/2002/01000/Prediction_of_Esophageal_Varices_in_Patients_With.16.aspx
Gorka W, al Mulla A, al Sebayel M, Altraif I, Gorka TS. Qualitative hepatic venous Doppler sonography versus portal flowmetry in predicting the severity of esophageal varices in hepatitis C cirrhosis. Am J Roentgenol. 1997 Aug 1;169(2):511–5.
Chang MH, Sohn JH, Kim TY, Son BK, Kim JP, Jeon YC, et al. [Non-endoscopic predictors of large esophageal varices in patients with liver cirrhosis]. Korean J Gastroenterol Taehan Sohwagi Hakhoe Chi. 2007 Jun;49(6):376–83.
Schwarzenberger E, Meyer T, Golla V, Sahdala NP, Min AD. Utilization of platelet count spleen diameter ratio in predicting the presence of esophageal varices in patients with cirrhosis. J Clin Gastroenterol. 2010 Feb;44(2):146–50.
Attia KA, N’dri-Yoman T, Talla P, Bathaix Y, Mahassadi A, Kissi H, et al. Facteurs prédictifs des signes endoscopiques d’hypertension portale sévère chez le cirrhotique en milieu africain : Etude de 131 cas. Médecine Afr Noire. 2003;50(3):109–14.
Hong W, Dong L, Jiang Z, Zhu Q, Jin S. Prediction of large esophageal varices in cirrhotic patients using classification and regression tree analysis. Clin São Paulo Braz. 2011;66(1):119–24.
Florent C, Meary N, Abdini E, Mostefa-Kara N. Histoire naturelle des varices œsophagiennes. Acta Endosc. 1995 Jul;25(4):319–26.
Kishimoto R, Chen M, Ogawa H, Wakabayashi MN, Kogutt MS. Esophageal varices: evaluation with transabdominal US. Radiology. 1998 Mar;206(3):647–50.
Sharma SK, Aggarwal R. Prediction of large esophageal varices in patients with cirrhosis of the liver using clinical, laboratory and imaging parameters. J Gastroenterol Hepatol. 2007 Nov;22(11):1909–15.
Augustin S, Muntaner L, Altamirano JT, González A, Saperas E, Dot J, et al. Predicting early mortality after acute variceal hemorrhage based on classification and regression tree analysis. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2009 Dec;7(12):1347–54.
Chiaramonte M, Stroffolini T, Ngatchu T, Rapicetta M, Lantum D, Kaptue L, et al. Hepatitis B virus infection in Cameroon: a seroepidemiological survey in city school children. J Med Virol. 1991 Feb;33(2):95–9.
Mbanya DN, Takam D, Ndumbe PM. Serological findings amongst first-time blood donors in Yaoundé, Cameroon: is safe donation a reality or a myth? Transfus Med Oxf Engl. 2003 Oct;13(5):267–73.
Zaman A, Hapke R, Flora K, Rosen HR, Benner K. Factors predicting the presence of esophageal or gastric varices in patients with advanced liver disease. Am J Gastroenterol. 1999 Nov;94(11):3292–6.
Pilette C, Oberti F, Aubé C, Rousselet MC, Bedossa P, Gallois Y, et al. Non-invasive diagnosis of esophageal varices in chronic liver diseases. J Hepatol. 1999 Nov;31(5):867–73.
Chalasani N, Imperiale TF, Ismail A, Sood G, Carey M, Wilcox CM, et al. Predictors of large esophageal varices in patients with cirrhosis. Am J Gastroenterol. 1999 Nov;94(11):3285–91.
Nakano R, Iwao T, Oho K, Toyonaga A, Tanikawa K. Splanchnic hemodynamic pattern and liver function in patients with cirrhosis and esophageal or gastric varices. Am J Gastroenterol. 1997 Nov;92(11):2085–9.
Liu C-H, Hsu S-J, Liang C-C, Tsai F-C, Lin J-W, Liu C-J, et al. Esophageal varices: noninvasive diagnosis with duplex Doppler US in patients with compensated cirrhosis. Radiology. 2008 Jul;248(1):132–9.
D’Amico G, Morabito A. Noninvasive markers of esophageal varices: another round, not the last. Hepatol Baltim Md. 2004 Jan;39(1):30–4.