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. 2019 Dec;19(4):3225-3234.
doi: 10.4314/ahs.v19i4.46.

The diagnostic accuracy of routine clinical findings for detection of esophageal varices in rural sub-Saharan Africa where schistosomiasis is endemic

Christopher K Opio  1 , Lalitha Rejani  1 , Francis Kazibwe  2 , Ponsiano Ocama  1
Affiliations

The diagnostic accuracy of routine clinical findings for detection of esophageal varices in rural sub-Saharan Africa where schistosomiasis is endemic

Christopher K Opio et al. Afr Health Sci. 2019 Dec.

Abstract

Background: Variceal upper gastrointestinal bleeding (UGIB) is common in sub-Saharan Africa (SSA). However, poor access to endoscopy services precludes the diagnosis of varices.

Objectives: We determined the diagnostic accuracy of routine clinical findings for detection of esophageal varices among patients with UGIB in rural SSA where schistosomiasis is endemic.

Methods: We studied patients with a history of UGIB. The index tests included routine clinical findings and the reference test was diagnostic endoscopy. Multivariable regression with post-estimation provided measures of association and diagnostic accuracy.

Results: We studied 107 participants with UGIB and 21% had active bleeding. One hundred and three (96%) had liver disease and 86(80%) varices. Factors associated with varices (p-value <0.05) were ≥ 4 lifetime episodes of UGIB, prior blood transfusion, splenomegaly, liver fibrosis, thrombocytopenia, platelet count spleen diameter ratio <909, and a dilated portal vein. Two models showed an overall diagnostic accuracy of > 90% in detection of varices with a number needed to misdiagnose of 13(number of patients who needed to be tested in order for one to be misdiagnosed by the test).

Conclusion: Where access to endoscopy is limited, routine clinical findings could improve the diagnosis of patients with UGIB in Africa.

The diagnostic accuracy of routine clinical findings for detection of esophageal varices in rural sub-Saharan Africa where schistosomiasis is endemic.

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Figures

Figure 1
Figure 1
Study flowchart describing enrollment and the proportion of participants from outpatients and inpatients with esophageal varices.
Figure 2
Figure 2
A nomogram of model 1 consisting of platelet count spleen diameter ratio ≤909, WHO peri-portal fibrosis patterns EF or X, number lifetime of episodes of UGIB≥4, heart rate ≥68beats/minute. This enables one to calculate output probabilities for predictive models with a visual approach. Estimate the probability of having varices through 3 steps. Step 1 -establish scores for all variable values, step 2-obtain the total score adding up all the scores obtained in the previous step, step 3-obtain the probability of the event (total Score -> Probability of event).
Figure 3
Figure 3
A nomogram of model 2 consisting of includes age ≤39 years, heart rate ≥68 beats/minute, palpable spleen, ≥4 Number lifetime of episodes of UGIB, platelet count< 140x109/L This enables one to calculate output probabilities for predictive models with a visual approach. Estimate the probability of having varices through 3 steps. Step 1 -establish scores for all variable values, step 2-obtain the total score adding up all the scores obtained in the previous step, step 3-obtain the probability of the event (total Score -> Probability of event).
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