Noninvasive predictors of esophageal varices in patients with hepatosplenic schistosomiasis mansoni

Nardelli, Mateus Jorge; Veiga, Zulane; Faria, Luciana Costa; Silva, Catherine Ferreira da; Barbosa, Fernanda A; Fernandes, Flávia; Perez, Renata de Mello; Villela-Nogueira, Cristiane Alves; Couto, Cláudia Alves

doi:10.1016/j.actatropica.2021.106283

Cited by 7 publications

(4 citation statements)

References 30 publications

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“…Establishing who to target for implementation and identifying the use cases for ultrasound staging systems are important considerations when putting together guidance to stage schistosomal PPF. Twenty-nine of the studies in this review considered some link between ultrasound findings of schistosomal PPF and clinical severity, for example prediction of oesophageal varices [ 62 – 64 ] or portal hypertension [ 50 , 65 ]. These concrete clinical outcomes can be linked to ultrasound staging systems and clinically justify their use, establishing prognostic associations for staging.…”

Section: Discussionmentioning

confidence: 99%

The role of point-of-care ultrasound in the assessment of schistosomiasis-induced liver fibrosis: A systematic scoping review

Ockenden,

Frischer,

Cheng

et al. 2024

PLoS Negl Trop Dis

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Background Abdominal ultrasound imaging is an important method for hepatic schistosomiasis diagnosis and staging. Several ultrasound staging systems have been proposed, each attempting to standardise schistosomal periportal fibrosis (PPF) diagnosis. This review aims to establish the role of ultrasound in the diagnosis and staging of schistosomal PPF, and to map the evolution of ultrasound staging systems over time, focusing on internal validation and external reproducibility. Methods A systematic search was undertaken on 21st December 2022 considering the following databases: PubMed/MEDLINE (1946-present), Embase (1974-present), Global Health (1973-present), Global Index Medicus (1901-present), and Web of Science Core Collection–Science Citation Index Expanded (1900-present) and the Cochrane Central Register of Controlled Trials (1996-present). Case reports, systematic reviews and meta-analyses, and studies exclusively using transient or shear-wave elastography were excluded. Variables extracted included study design, study population, schistosomal PPF characteristics, and diagnostic methods. The PRISMA-ScR (2018) guidelines were followed to inform the structure of the scoping analysis. Results The initial search yielded 573 unique articles, of which 168 were removed after screening titles and abstracts, 43 were not retrieved due to full texts not being available online or through inter-library loans, and 170 were excluded during full text review. There were 192 remaining studies eligible for extraction. Of the extracted studies, 61.8% (76/123) of studies that reported study year were conducted after the year 2000. Over half of all extracted studies (59.4%; 114/192) were conducted in Brazil (26.0%; 50/192), China (18.8%; 36/192) or Egypt (14.6%; 28/192). For the species of schistosome considered, 77.6% (149/192) of studies considered S. mansoni and 21.4% (41/192) of studies considered S. japonicum. The ultrasound staging systems used took on three forms: measurement-based, feature-based and image pattern-based. The Niamey protocol, a measurement and image pattern-based system, was the most used among the staging systems (32.8%; 63/192), despite being the most recently proposed in 1996. The second most used was the Cairo protocol (20.8%; 40/192). Of the studies using the Niamey protocol, 77.8% (49/63) only used the image patterns element. Where ultrasound technology was specified, studies after 2000 were more likely to use convex transducers (43.4%; 33/76) than studies conducted before 2000 (32.7%; 16/49). Reporting on ultrasound-based hepatic diagnoses and their association with clinical severity was poor. Just over half of studies (56.2%; 108/192) reported the personnel acquiring the ultrasound images. A small number (9.4%; 18/192) of studies detailed their methods of image quality assurance, and 13.0% (25/192) referenced, discussed or quantified the inter- or intra-observer variation of the staging system that was used. Conclusions The exclusive use of the image patterns in many studies despite lack of specific acquisition guidance, the increasing number of studies over time that conduct ultrasound staging of schistosomal PPF, and the advances in ultrasound technology used since 2000 all indicate a need to consider an update to the Niamey protocol. The protocol update should simplify and prioritise what is to be assessed, advise on who is to conduct the ultrasound examination, and procedures for improved standardisation and external reproducibility.

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Section: Discussionmentioning

confidence: 99%

The role of point-of-care ultrasound in the assessment of schistosomiasis-induced liver fibrosis: A systematic scoping review

Ockenden,

Frischer,

Cheng

et al. 2024

PLoS Negl Trop Dis

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“…However, increased TE values indicate portal hypertension and esophageal varices. Hence, further studies are needed to establish precise cut-offs for detecting fibrosis in schistosomiasis and patients at acute risk of variceal bleeding [ 31 ]. Third, the cost-effectiveness of the TE screening in LMICs must be assessed in future studies.…”

Section: Discussionmentioning

confidence: 99%

Rapid appraisal of liver diseases using transient elastography, abdominal ultrasound, and microbiology in Côte d’Ivoire: A single-center study

Leibenguth,

Coulibaly,

Silué

et al. 2024

PLoS Negl Trop Dis

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Background Liver diseases of infectious and non-infectious etiology cause considerable morbidity and mortality, particularly in low- and middle-income countries (LMICs). However, data on the prevalence of liver diseases and underlying risk factors in LMICs are scarce. The objective of this study was to elucidate the occurrence of infectious diseases among individuals with chronic liver damage in a rural setting of Côte d’Ivoire. Methodology In 2021, we screened 696 individuals from four villages in the southern part of Côte d’Ivoire for hepatic fibrosis and steatosis, employing transient elastography (TE) and controlled attenuation parameter (CAP). We classified CAP ≥248 dB/m as steatosis, TE ≥7.2 kPa as fibrosis, and did subgroup analysis for participants with TE ranging from 7.2 kPa to 9.1 kPa. Clinical and microbiologic characteristics were compared to an age- and sex-matched control group (TE <6.0 kPa; n = 109). Stool samples were subjected to duplicate Kato-Katz thick smears for diagnosis of Schistosoma mansoni. Venous blood samples were examined for hepatitis B and hepatitis C virus. Additionally, an abdominal ultrasound examination was performed. Principal findings Among 684 individuals with valid TE measurements, TE screening identified hepatic pathologies in 149 participants (17% with fibrosis and 6% with steatosis). 419 participants were included for further analyses, of which 261 had complete microbiologic analyses available. The prevalence of S. mansoni, hepatitis B, and hepatitis C were 30%, 14%, and 7%, respectively. Logistic regression analysis revealed higher odds for having TE results between 7.2 kPa and 9.1 kPa in individuals with S. mansoni infection (odds ratio [OR] = 3.02, 95% confidence interval [CI] = 1.58–5.76, P = 0.001), while HCV infection (OR = 5.02, 95% CI = 1.72–14.69, P = 0.003) and steatosis (OR = 4.62, 95% CI = 1.60–13.35, P = 0.005) were found to be risk factors for TE ≥9.2 kPa. Conclusions/significance Besides viral hepatitis, S. mansoni also warrants consideration as a pathogen causing liver fibrosis in Côte d’Ivoire. In-depth diagnostic work-up among individuals with abnormal TE findings might be a cost-effective public health strategy.

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“…Role in non-cirrhotic PHT SSM also has emerging roles in those with non-cirrhotic portal hypertension (NCPH), for example, hepatosplenic schistosomiasis, 79 extrahepatic portal vein obstruction, [80][81][82][83][84] Budd-Chiari syndrome, 85 biliary atresia, [86][87][88][89] idiopathic PHT, 90 Gaucher disease, 91 etc. Together, these studies indicate that SSM is an accurate predictor of NCPH, particularly in the extrahepatic portal vein obstruction subgroup.…”

Section: Open Accessmentioning

confidence: 99%

Spleen stiffness measurement as a non-invasive assessment in patients with portal hypertension

Xu,

Liu,

Zhu

et al. 2024

egastro

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For patients with advanced chronic liver disease who are in a compensated state, the development of portal hypertension (PHT) can lead to a heightened risk of hepatic decompensation and mortality. This underscores the importance of timely and appropriate treatment to manage the condition and prevent further complications. The current gold standard procedure for determining PHT is the hepatic venous pressure gradient, but its invasiveness limits its usage in clinical practice and larger trials of novel agents. The current clinical demand for accurate, validated and non-invasive methods to assess the severity of PHT remains unmet. One potential non-invasive option is tissue elastography, which examines the elastic behaviour of tissue after a force has been applied. This method involves quantifying alterations in the biomechanical properties of the liver or spleen in patients with cirrhosis. Available methods are various, including transient elastography, shear wave elastography, acoustic radiation force impulse and magnetic resonance elastography. Importantly, the measurement of spleen stiffness appears to outperform liver stiffness as a direct and dynamic indicator of portal pressure, offering the potential to monitor PHT and evaluate improvements in PHT as a marker for clinical outcomes.

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Noninvasive predictors of esophageal varices in patients with hepatosplenic schistosomiasis mansoni

Cited by 7 publications

References 30 publications

The role of point-of-care ultrasound in the assessment of schistosomiasis-induced liver fibrosis: A systematic scoping review

The role of point-of-care ultrasound in the assessment of schistosomiasis-induced liver fibrosis: A systematic scoping review

Rapid appraisal of liver diseases using transient elastography, abdominal ultrasound, and microbiology in Côte d’Ivoire: A single-center study

Spleen stiffness measurement as a non-invasive assessment in patients with portal hypertension

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