Intérêt du gradient de concentration sérum-ascite en albumine dans le diagnostic des varices oesophagiennes chez le cirrhotique africain, Abidjan (Côte d'Ivoire)Interest serum-ascites albumin concentration gradient in the diagnosis of esophageal varices in cirrhotic African, Abidjan (Côte d'Ivoire) Résumé Buts : Déterminer la corrélation entre le gradient de concentration sérum-ascite en albumine (GASA) et la prédic-tion des varices oesophagiennes (VO) et autres paramètres de l'hypertension portale (HTP) à savoir signes rouges, grades des varices, varices cardiotubérositaires et les gastropathies d'HTP chez le cirrhotique noir africain en Côte d'Ivoire. Patients et méthode : Etude transversale rétrospective portant sur 113 dossiers médicaux de patients présentant une ascite liée à l'HTP. La fibroscopie digestive haute pour la recherche de signes d'HTP. Le dosage des protéines dans le sérum et le liquide d'ascite a été réalisé par les méthodes chimiques courantes. La sensibilité et la spécificité obtenues par l'aire sous la courbe ROC (Receiver-Operating-Characteristic). Résultats : A 1,1 g/dl, le GASA prédisait les VO avec une sensibilité (53,3%), une spécificité (80%) pour une performance diagnostique faible (64%). A partir de 1,5 g/dl du SAAG, la spécificité était maximale (100%) mais on relevait 40% de faux-négatifs. Pour une valeur-seuil de -1,240 g/dl, la performance diagnostique du GASA était meilleure avec une sensibilité (96%), une spécificité (55%) pour une performance diagnostique à 84%. Conclusion : La valeur seuil du GASA efficace pour la détection des VO était inférieure chez les sujets africains en raison des facteurs nutritionnel et infectieux fréquents dans ces pays à faible revenu. Mots clés Varices oesophagiennes · Gradient · Albumine · Cirrhose · AfriqueAbstract Aims: To determine the correlation between the concentration Serum Ascites Albumin Gradient (SAAG) and the prediction of esophageal varices (VO) and other parameters of portal hypertension (PHT), namely red signs grades varicose veins, varicose veins and cardio tuberosity, the gastropathie portal hypertension among African blacks cirrhotic Ivory Coast. Patients and Methods: A retrospective cross-sectional study of 113 medical records of patients with ascites associated with PH. The gastroscopy to search for signs of HTP. The protein assay in serum and ascitic fluid produced by standard chemical methods. The sensitivity and specificity obtained by the area under the ROC curve (Receiver-Operating-Characteristic). Results: 1.1 g/dl, the SAAG predicted VO with a sensitivity (53.3%), specificity (80%) for low diagnostic accuracy (64%). From 1.5 g/dl of SAAG, specificity was highest (100%) but fell 40% false-negative. For a threshold value of -1.240 g/dl, the diagnostic performance of SAAG was better with a sensitivity (96%), specificity (55%) for a diagnostic accuracy of 84%. Conclusion: The threshold value of SAAG effective for the detection of VO was lower among African because of frequent nutritional and infectious factors in these low-in...

ABSTRACT

Purpose: To show the interest of the serum-ascites concentration gradient in albumin (SAAG) in the etiological diagnosis of ascites in African black. Materiel and Methods: This was a monocentric observational and analytical study performed on patients over 15 years old and hospitalized in the Hepato-Gastroenterology department of Cocody from January 1st, 2010 to March 31st, 2017 for ascites. The cytology and chemistry of the ascites fluid and the protidogram were performed. The main outcome measure was the prediction of portal hypertension (PHT) or non-portal hypertension related causes of ascites from SAAG. Results: The hospital prevalence of ascites was 11%. There were 82 women (46.9%) and 93 men (53.1%) with a sex ratio (M/F) of 1.1. SAAG was low in 68.6% of cases and high in 31.4% of cases. The most common etiologies were post-viral cirrhosis (74%), HCC (16.60%) and peritoneal tuberculosis (13.7%) respectively. In the case of high SAAG, 91% of ascites related to PHT were observed, but also 77.5% of a low SAAG corresponded to ascites related to PHT (p = 0.024) with Se = 35% Sp = 84% and accuracy = 44%. All patients with peritoneal tuberculosis had a SAAG low of less than 1.1 g/dl significantly (p = 0.002). SAAG had a diagnostic performance of 89% in peritoneal tuberculosis at the cutoff value of −1.24 g/dl (AUROC = 0.91, Se = 96%, Sp = 86%) while in post viral hepatitis cirrhosis at a threshold of 0.58 g/dl the diagnostic performance was 60% (AUROC = 0.69, Se = 53%, Sp = 79%). Conclusion: The simple technical SAAG, allowing to distinguish the ascites linked to the PHT and the ascites not bound to the PHT, can be used like a method of diagnosis of the etiologies of the ascites especially in the peritoneal tuberculosis in the African countries low income.

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