Intérêt du gradient de concentration sérum-ascite en albumine dans le diagnostic des varices œsophagiennes chez le cirrhotique africain, Abidjan (Côte d’Ivoire)

Abstract

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...

Interest of Serum-Ascites Albumin Concentration Gradient in the Diagnosis of Portal Hypertension in Cirrhotic Patients

“…In our series, the median SAAG was 1.40 g/dl; the one found by Okon et al in Ivory Coast [12] was −0.30 g/dl. The majority of patients in our study had a SAAG high ≥1.10 g/dl (65.6%) as in the studies of Gurubacharya et al [14] in Nepal (78.13%), and of Suresh et al [15] in India (79%).…”

“…Shahed et al [16] in Bangladesh had only included patients with high SAAG in their study. On the other hand, in the Okon et al study in Ivory Coast [12], the majority of patients (68.2%) had low SAAG. For these Ivorian authors, the condition of malnutrition of their patients causing hypoalbuminemia, and the infection of ascites fluid could explain the decrease in the value of SAAG.…”

“…In the work of Torres et al [17], Demirel et al [18], Suresh et al [15], Gurubacharya et al [14], and Shahed et al [16], EV were consistently present in patients at the threshold of 2 g/dl. Apart from Shahed et al [16] who did not include patients with low SAAG <1.10 g/dl in their study, none of the patients had EV at a low SAAG in the Torres et al [17], Demirel et al [18], and Gurubacharya et al [14] studies contrary to the study of Okon et al [12], and ours where the probability of presence of EV is not Open Journal of Gastroenterology zero when the SAAG is low. Low SAAG < 1.10 g/dl was not a parameter to rule out the existence of EV in our study; on the other hand, high SAAG ≥ 1.10 g/dl significantly predicted the presence of EV.…”

“…From a SAAG ≥1.50 g/dl, 3 out of 4 patients had significant EV. For Okon et al [12], EV were significantly more prevalent in SAAG high ≥1.10 g/dl (71.95%) and were almost constant from SAAG ≥1.50 g/dl. In the work of Torres et al [17], Demirel et al [18], Suresh et al [15], Gurubacharya et al [14], and Shahed et al [16], EV were consistently present in patients at the threshold of 2 g/dl.…”

“…Studies on non-invasive methods of EV including platelet ratio and spleen diameter have been conducted in african cirrhotic subjects [10] [11]. In Ivory Coast, a study evaluating SAAG and the endoscopic parameters in 2015 showed a link between a high threshold of SAAG and the presenceof EV [12]. The use of SAAG can be considered as an indirect parameter for the detection of EV and be useful in regions where there is a shortage of human and material resources for the realization of the UGF.…”