scholarly journals Schistosoma mansoni-related periportal fibrosis; can we use APRI and PSDR levels in the real-time selection of patients for targeted endoscopy in a resource-limited setting? A case-control study

2020 ◽  
Author(s):  
Daniel W. Gunda ◽  
Elizabeth F. Mtui ◽  
Paulina M. Manyiri ◽  
David C. Majinge ◽  
Semvua B. Kilonzo ◽  
...  
Keyword(s):  
Schistosoma Mansoni ◽  
Esophageal Varices ◽  
Case Control Study ◽  
Case Control ◽  
Potential Utility ◽  
Non Invasive ◽  
Periportal Fibrosis ◽  
Resource Limited ◽  
Control Study ◽  
Limited Setting

Abstract Background Schistosoma mansoni related hepatic fibrosis is usually associated with hemodynamic alteration with increased mortality due to bleeding varices. The diagnosis of varices before bleeding imposes a big challenge in resource-limited countries using endoscopy. Published evidence on the utility of non-invasive clinical tools in predicting the presence of varices among patients with S. mansoni related periportal fibrosis is still inadequate including Aspartate to platelet ratio index (APRI) and Platelet to splenic diameter ratio (PSDR) levels. This study describes the determinants of portal varices and assesses the potential utility of the APRI and PSDR level in the discrimination of portal varices among patients with S. mansoni related periportal fibrosis (PPF). Methods A case-control study using cross-sectional data was done among patients with Schistosoma mansoni related periportal fibrosis at Bugando Medical Centre, in Mwanza Tanzania. Socio-demographic, laboratory, ultrasound, and upper digestive endoscopic information were collected for analysis using STATA 13. The prevalence of varices was calculated and its associated factors were determined by logistic regression. The sensitivity and specificity of independent factors were determined to assess their potential utility in discriminating the presence of portal varices in patients with PPF.Results In total, 250 patients were included in this study, 109 (43.6%; 95%CI: 37.3-.49.9) of them had varices. On multivariate analysis the odds of having varices were independently increased among patients with higher APRI levels than 1.51, (AOR: 5.8; 95%CI: 3.1-11.1; p<0.001) and PSDR levels that were lower than 5700 (AOR: 5.9; 95%CI: 3.2-11.2; p<0.001). Both APRI and PSDR levels had significantly high sensitivity and specificity in predicting the presence of esophageal varices. However, the combined values of APRI and PSDR had higher specificity than any of the two markersConclusions This study indicates that varices are a common encounter among patients with S. mansoni related periportal fibrosis and it is independently associated with higher APRI and lower PSDR levels suggesting that these tools are potential discriminators of varices in this subgroup of patients. The reproducibility of these results should further be assessed longitudinally as potential non-invasive tools in selecting patients at high risk of having esophageal varices who could benefit from the targeted endoscopic intervention in a resource-limited setting like ours.

scholarly journals Schistosoma mansoni-related periportal fibrosis; can we use APRI and PSDR levels in the real-time selection of patients for targeted endoscopy in a resource-limited setting? A case-control study

2020 ◽  
Author(s):  
Daniel W. Gunda ◽  
Elizabeth F. Mtui ◽  
Paulina M. Manyiri ◽  
David C. Majinge ◽  
Semvua B. Kilonzo ◽  
...  
Keyword(s):  
Schistosoma Mansoni ◽  
Esophageal Varices ◽  
Case Control Study ◽  
Case Control ◽  
Potential Utility ◽  
Non Invasive ◽  
Periportal Fibrosis ◽  
Resource Limited ◽  
Control Study ◽  
Limited Setting

Abstract Background Schistosoma mansoni related hepatic fibrosis is usually associated with hemodynamic alteration with increased mortality due to bleeding varices. The diagnosis of varices before bleeding imposes a big challenge in resource-limited countries using endoscopy. Published evidence on the utility of non-invasive clinical tools in predicting the presence of varices among patients with S. mansoni related periportal fibrosis is still inadequate including Aspartate to platelet ratio index (APRI) and Platelet to splenic diameter ratio (PSDR) levels. This study describes the determinants of portal varices and assesses the potential utility of the APRI and PSDR level in the discrimination of portal varices among patients with S. mansoni related periportal fibrosis (PPF). Methods A case-control study using cross-sectional data was done among patients with Schistosoma mansoni related periportal fibrosis at Bugando Medical Centre, in Mwanza Tanzania. Socio-demographic, laboratory, ultrasound, and upper digestive endoscopic information were collected for analysis using STATA 13. The prevalence of varices was calculated and its associated factors were determined by logistic regression. The sensitivity and specificity of independent factors were determined to assess their potential utility in discriminating the presence of portal varices in patients with PPF.Results In total, 250 patients were included in this study, 109 (43.6%; 95%CI: 37.3-.49.9) of them had varices. On multivariate analysis the odds of having varices were independently increased among patients with higher APRI levels than 1.51, (AOR: 5.8; 95%CI: 3.1-11.1; p<0.001) and PSDR levels that were lower than 5700 (AOR: 5.9; 95%CI: 3.2-11.2; p<0.001). Both APRI and PSDR levels had significantly high sensitivity and specificity in predicting the presence of esophageal varices. However, the combined values of APRI and PSDR had higher specificity than any of the two markersConclusions This study indicates that varices are a common encounter among patients with S. mansoni related periportal fibrosis and it is independently associated with higher APRI and lower PSDR levels suggesting that these tools are potential discriminators of varices in this subgroup of patients. The reproducibility of these results should further be assessed longitudinally as potential non-invasive tools in selecting patients at high risk of having esophageal varices who could benefit from the targeted endoscopic intervention in a resource-limited setting like ours.

scholarly journals Schistosoma mansoni-related periportal fibrosis; can we use APRI and PSDR levels in the real-time selection of patients for targeted endoscopy in a resource-limited setting? A case–control study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniel W. Gunda ◽  
Elizabeth F. Mtui ◽  
Paulina M. Manyiri ◽  
David C. Majinge ◽  
Semvua B. Kilonzo ◽  
...  
Keyword(s):  
Schistosoma Mansoni ◽  
Case Control Study ◽  
Validation Cohort ◽  
Case Control ◽  
Derivation Cohort ◽  
Non Invasive ◽  
Periportal Fibrosis ◽  
Resource Limited ◽  
Control Study ◽  
Limited Setting

Abstract Background Schistosoma mansoni related hepatic fibrosis is usually associated with hemodynamic alteration with increased mortality due to bleeding varices. The diagnosis of varices before bleeding imposes a big challenge in resource-limited countries using endoscopy. Published evidence on the utility of non-invasive clinical tools in predicting the presence of varices among patients with S. mansoni related periportal fibrosis is still inadequate including Aspartate to platelet ratio index (APRI) and Platelet to splenic diameter ratio (PSDR) levels. This study describes the determinants of portal varices and assesses the potential utility of the APRI and PSDR level in the discrimination of portal varices among patients with S. mansoni related periportal fibrosis (PPF). Methods A case–control study using cross-sectional data was done among patients with Schistosoma mansoni related periportal fibrosis at Bugando Medical Centre, in Mwanza Tanzania. The derivation cohort included patients enrolled between 2015 and 2019 and the validation cohort included patients enrolled from 2019 till March 2021. Socio-demographic, laboratory, ultrasound, and upper digestive endoscopic information were analyzed using STATA 13. The prevalence and determinants of varices were determined by logistic regression. The sensitivity and specificity of independent factors were determined to assess their utility in discriminating the presence of portal varices in patients with PPF. Results In total, 250 patients were included in the derivation cohort, 109 (43.6%; 95% CI 37.3–49.9) of them had varices. The odds of having varices were independently increased among patients with higher APRI levels than 1.51, (AOR: 5.8; 95% CI 3.1–11.1; p < 0.001) and PSDR levels that were lower than 5700 (AOR: 5.9; 95% CI 3.2–11.2; p < 0.001). Both APRI and PSDR levels had significantly high sensitivity and specificity in predicting the presence of esophageal varices. However, the combined values of APRI and PSDR had higher specificity than any of the two markers. Of the 200 patients in the validation cohort 94 (47.0%; 95% CI 40.0–54.2) had varices, the discriminative power of the final model and the predictive ability of both APRI, PSDR, and APRI-PSDR combined levels were highly maintained. Conclusions This study indicates that varices are a common encounter among patients with S. mansoni related periportal fibrosis and it is independently associated with higher APRI and lower PSDR levels suggesting that these tools are potential discriminators of varices in this subgroup of patients. The reproducibility of these results should further be assessed longitudinally as potential non-invasive tools in selecting patients at high risk of having esophageal varices who could benefit from the targeted endoscopic intervention in a resource-limited setting like ours.

scholarly journals Schistosoma mansoni -related periportal fibrosis; are APRI and PSDR levels of any potential utility in a well-timed selection of patients for targeted endoscopy in a resource-limited setting?: a case-control clinic-based study

2020 ◽  
Author(s):  
Daniel W. Gunda ◽  
Elizabeth F. Mtui ◽  
Paulina M. Manyiri ◽  
David C. Majinge ◽  
Semvua B. Kilonzo ◽  
...  
Keyword(s):  
Schistosoma Mansoni ◽  
Sensitivity And Specificity ◽  
Esophageal Varices ◽  
Resource Limited Setting ◽  
Potential Utility ◽  
Non Invasive ◽  
Periportal Fibrosis ◽  
Resource Limited ◽  
Published Evidence ◽  
Limited Setting

Abstract Background Schistosoma mansoni related hepatic fibrosis is usually associated with hemodynamic alteration with increased mortality due to bleeding varices. The diagnosis of varices before bleeding imposes a big challenge in resource-limited countries using endoscopy. Published evidence on the utility of non-invasive clinical tools in predicting the presence of varices among patients with S. mansoni related periportal fibrosis is still inadequate including APRI and PSDR levels. This study describes the determinants of portal varices and assesses the potential utility of the APRI and PSDR level in the discrimination of portal varices among patients with S. mansoni related periportal fibrosis. Methods All patients with periportal fibrosis were cross-sectionally assessed for the presence of esophageal varices at Bugando medical centre, in Mwanza Tanzania. Socio-demographic, laboratory and ultrasound data were collected for analysis using STATA 13. The prevalence of varices and associated factors were determined, and the sensitivity and specificity of independent factors were assessed to determine their utility in discriminating presence of varices in patients with PPF. Results In total, 250 patients were included in this study, 109 (43.6%; 95%CI: 37.3-.49.9) of them had varices. On multivariate analysis the odds of having varices were independently increased among patients with higher median APRI levels, (1.51; vs. 0.9; AOR: 5.6; 95%CI: 3.1-10.1; p=<0.001) and PSDR levels that were lower than 5700 (AOR: 3.9; 95%CI: 2.0-7.6; p<0.001. Both APRI and PSDR levels had significantly high sensitivity and specificity in predicting the presence of esophageal varices. Conclusions This study indicates that varices are a common encounter among patients with S. mansoni related periportal fibrosis and it is independently associated with higher median APRI and lower PSDR levels suggesting that these tools are potential discriminators of varices in this subgroup of patients. The reproducibility of these results should further be assessed longitudinally as potential non-invasive tools in selecting patients at high risk of having esophageal varices who could benefit from the targeted endoscopic intervention in a resource-limited setting like ours.

Acceptance of a new non-invasive fetal monitoring system and attitude for telemedicine approaches in obstetrics: a case–control study

2018 ◽  
Vol 298 (6) ◽  
pp. 1085-1093 ◽  
Author(s):  
Katharina Schramm ◽  
Florian Lapert ◽  
Juliane Nees ◽  
Carlijn Lempersz ◽  
S. Guid Oei ◽  
...  
Keyword(s):  
Monitoring System ◽  
Case Control Study ◽  
Fetal Monitoring ◽  
Case Control ◽  
Non Invasive ◽  
Control Study

548 A new non-invasive technique in primary sclerosing cholangitis (PSC): A case-control study

2004 ◽  
Vol 40 ◽  
pp. 161
Author(s):  
V. Macchi ◽  
E. Bezzon ◽  
A. Floreani ◽  
R. Pasini ◽  
P. Marchesi ◽  
...  
Keyword(s):  
Primary Sclerosing Cholangitis ◽  
Sclerosing Cholangitis ◽  
Case Control Study ◽  
Case Control ◽  
Invasive Technique ◽  
Non Invasive ◽  
Control Study

scholarly journals The Copenhagen case-control study of bladder cancer: role of smoking in invasive and non-invasive bladder tumours.

1987 ◽  
Vol 41 (1) ◽  
pp. 30-36 ◽  
Author(s):  
O M Jensen ◽  
J Wahrendorf ◽  
M Blettner ◽  
J B Knudsen ◽  
B L Sorensen
Keyword(s):  
Bladder Cancer ◽  
Case Control Study ◽  
Case Control ◽  
Non Invasive ◽  
Control Study ◽  
Bladder Tumours

scholarly journals Identifying Possible Hepatic Fibrosis of Hepatitis B Origin Using Non-invasive Markers: A Case-control Study in the South West Region of Cameroon

2019 ◽  
pp. 1-12
Author(s):  
Kukwah Anthony Tufon ◽  
Henry Dilonga Meriki ◽  
Kwenti Emmanuel Tebit ◽  
Teuwafeu Denis Georges ◽  
Nyeke James Tony ◽  
...  
Keyword(s):  
Liver Fibrosis ◽  
Hepatitis B ◽  
Hepatic Fibrosis ◽  
Case Control Study ◽  
Case Control ◽  
Non Invasive ◽  
West Region ◽  
South West ◽  
Control Study ◽  
South West Region

Aim: HBV infection is known to cause liver fibrosis as well as some extrahepatic manifestations. We aimed at assessing hematological changes and identifying possible hepatic fibrosis of Hepatitis B origin using non-invasive markers (NIMs). Study Design: A hospital-based Case-control study Place and Duration of Study: Conducted at the Buea Regional Hospital, South West Region of Cameroon from February 2016 to December 2017 Methods: We enrolled HBV infected treatment naïve patients and “healthy” controls. All participants were subjected to alanine aminotransferase (ALT) and aspartate aminotransferase (AST) measurement, Full blood count (FBC), HBsAg, anti-HBc, HIV and HCV tests. Aspartate-platelet ratio index (APRI), fibrosis based on 4 factors (FIB-4), age-platelet index (API) and AST/ALT ratio (AAR) were generated from the test results. A questionnaire was administered to collect demographic data, alcohol consumption and history of liver/kidney disease or metabolic syndrome. Results: A total of 202 cases and 202 controls were enrolled. Hematocrit (HCT) was significantly higher (p<0.001) in cases than controls. The controls had significantly higher mean values for platelet (p=0.005), neutrophil (p=0.032) and number of individuals with AST/ALT ratio (AAR) ≥1. Liver fibrosis was significantly associated with cases than controls based on APRI (OR:6.06, CI:3.59-10.24), FIB-4 (OR:5.35, CI:2.75-10.39) and API (OR:8.02, CI:1.81-35.55). Among the HBV infected cases, 69 (34.2%), 36(17.8%) and 8(4.0%) had results indicative of fibrosis from at least 2, at least 3 and all 4 NIMs respectively. AAR detected possible fibrosis in 136 HBV infected cases of which up to 77 (56.6%) were not detected as fibrosis by the other NIMs. Conclusion: HBV infection affects neutrophil percentage, HCT, PLT, APRI, FIB-4 and API in our study population. AAR did not prove to be a reliable NIM. Using at least 3 NIMs for HBV infected patients can significantly scale up their reliability for determining liver fibrosis in clinical practice.

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