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Observational Study
. 2020 Dec 26;20(1):428.
doi: 10.1186/s12876-020-01581-9.

Ambulatory end-stage liver disease in Ghana; patient profile and utility of alpha fetoprotein and aspartate aminotransferase: platelet ratio index

Yvonne Ayerki Nartey  1 , Yaw Asante Awuku  2 , Adwoa Agyei-Nkansah  3 , Amoako Duah  4 , Sally Afua Bampoh  5 , Joshua Ayawin  6 , Shadrack Osei Asibey  7 , Niklas K Björkström  8 , Weimin Ye  9 , Mary Yeboah Afihene  10 , Lewis Rowland Roberts  11 , Amelie Plymoth  9
Affiliations
Observational Study

Ambulatory end-stage liver disease in Ghana; patient profile and utility of alpha fetoprotein and aspartate aminotransferase: platelet ratio index

Yvonne Ayerki Nartey et al. BMC Gastroenterol. .

Abstract

Background: End-stage liver disease (ESLD) is a major burden on public health, particularly in sub-Saharan Africa, where hepatitis B virus (HBV) is an important risk factor. We aimed to describe clinical characteristics of ESLD from cirrhosis or hepatocellular carcinoma (HCC) and the performance of aspartate aminotransferase (AST)-platelet ratio index (APRI) and alpha fetoprotein (AFP) in Ghana.

Methods: We performed an observational cross-sectional study in outpatient hepatology clinics at three teaching hospitals in Ghana, West Africa. One hundred and forty-one HCC, 216 cirrhosis and 218 chronic HBV patients were recruited by convenience sampling. Sociodemographic, history and examination, laboratory, and disease staging information were shown using descriptive statistics. Performance of the APRI score in diagnosis of cirrhosis and AFP in the diagnosis of HCC was determined using AUROC analysis.

Results: Median age at presentation was 44 years for HCC and 46 years for cirrhosis. HBV was found in 69.5% of HCC and 47.2% of cirrhosis cases, and HCV in 6.4% and 3.7% respectively. APRI cut-off of 2 had sensitivity of 45.4% and specificity of 95% in diagnosis of cirrhosis, and cut-off of 1 had sensitivity of 75.9% and specificity of 89%. AUC of AFP was 0.88 (95% CI 0.81-0.94) in diagnosis of HCC. Low monthly income was associated with lower odds of undertaking AFP. Thirty one percent of cirrhotic persons were Child-Pugh C, and 67.9% of HCC patients had advanced or terminal disease at presentation.

Conclusions: Our findings emphasize the young age of ESLD patients in Ghana and the advanced nature at presentation. It highlights shortcomings in surveillance and the need for policies to address the burden and improve outcomes in Ghana.

Keywords: AST to platelet ratio index (APRI) score; Alpha fetoprotein (AFP); End-stage liver disease; Ghana; Hepatocellular carcinoma; Liver cirrhosis; Sub-Saharan Africa.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Map of Ghana showing location of sites involved in study (Created with mapchart.net)
Fig. 2
Fig. 2
Age adjusted odds ratio of undertaking AFP and HBV DNA test
Fig. 3
Fig. 3
Comparison of HBV DNA, APRI Score and AFP among HCC, cirrhosis and chronic HBV patients
Fig. 4
Fig. 4
ROC curve of AFP for the diagnosis of hepatocellular carcinoma
See this image and copyright information in PMC

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