Dépistage de la stéatose hépatique par le Fibroscan/CAP chez les sujets noirs africains porteurs d'une Hépatite Virale B chronique en Côte d'Ivoire / Fibroscan/CAP screening for hepatic steatosis in black African subjects with chronic Viral Hepatitis B in Ivory Coast

Context and objectives As the global epidemic of obesity and metabolic syndrome progresses, the coexistence of fatty liver disease in patients with chronic viral hepatitis B (VHB) becomes significant. The objective of this work was to determine the frequency of hepatic steatosis assessed by Fibroscan/CAP (Controlled Attenuation Parameter) in patients with chronic VHB in Côte d'Ivoire. Methods. The study included 83 patients with chronic VHB. These were black patients who had performed a Fibroscan/CAP during the recruitment period and were willing to participate in the study. Patients with significant alcohol consumption, a secondary cause of hepatic steatosis, another liver disease regardless of the etiology associated with VHB were not included. Results. The frequency of hepatic steatosis in chronic HBV carriers assessed by CAP in our study population was 48.19 %, including 24.10 % of severe steatosis. Obesity was statistically correlated with the presence of steatosis in our patients. Patients who had steatosis on ultrasound were 5 times more likely to have steatosis on CAP. Significant fibrosis was insignificantly associated with steatosis. Conclusion. The frequency of fatty liver disease detected by fibroscan/CAP is high in patients with chronic VHB.

Contexte et objectifs Avec la progression de l'épidémie mondiale d'obésité et du syndrome métabolique, la coexistence d'une stéatose hépatique chez les patients porteurs d'une hépatite virale B chronique devient non négligeable. L'objectif de ce travail était de déterminer la fréquence de la stéatose hépatique chez les patients porteurs d'une hépatite virale B (HVB) chronique. Méthodes. Il s'agissait d'une série des cas de HVB de race noire, ayant réalisé un Fibroscan/CAP pendant la période du recrutement et consentants à participer à l'étude. Les patients ayant une consommation d'alcool significative, une cause secondaire de stéatose hépatique, une autre hépatopathie quelle que soit l'étiologie associée à l'hépatite B n'ont pas été inclus. Résultats. Quatre-vingt-trois patients porteurs d'une HVB ont été inclus. La fréquence de la stéatose hépatique chez les porteurs du VHB chronique était de 48,19 % dont 24,10 % de stéatose sévère. L'obésité était statistiquement corrélée à la présence d'une stéatose chez nos patients. Les patients qui avaient une stéatose à l'échographie étaient 5 fois plus à risque d'avoir une stéatose au CAP. La fibrose significative était associée de façon non significative à la stéatose. Conclusion : Près de la moitié des patients porteurs d'une hépatite virale B chronique présente une stéatose hépatique.

Determinants of in-Hospital Mortality in a Gastroenterology Unit in Côte d’Ivoire (West Africa): An Advocacy for a Social Security Policy.

Background: The in-hospital mortality is a major concern in Africa. The study is aimed at providing the determinants of in-hospital mortality of patients admitted in the gastroenterology and medicine unit (GMU) of the teaching hospital of Yopougon (Abidjan, Ivory Coast). Patients and Methods: A retrospective cohort of 341 patients (males: 53%, mean age: 43 years) admitted in the GMU during 2009 were studied. Socio-demographic, clinical, biological characteristics of patients were retrieved. Survival probability and determinants of in-hospital mortality were respectively determined by the Kaplan Meier curve and Cox model. Results: Among the 341 patients admitted, 79 (23.2%) died in the GMU. The in-hospitalmortality rate was 4.3 (95%IC: 3.3-5.2) death per 100 patients-day. The main diagnoses were HIV/AIDS (15%), cirrhosis (14.4%), hepatocellular carcinoma (13.5%), tuberculosis (12.6%) and gastroenteritis (7.9%). Survival probabilities were higher in patients with Financial support (FS) to face medical fees (log rank test = 10.7, P=.001), with no comorbidities (log rank test= 4.5, P=.03) compared to those without, and when diagnoses were established than unknown (log rank test=11. 5, P=.001). In multivariate analysis, prothrombin time <65% (aHR=2.6, P=.02), creatinine level (aHR: 1.02, P=.02), HIV/AIDS or tuberculosis (aHR=0.44, P=.01), non malignant digestive diseases (aHR=0.34, P=.01) and FS (aHR=0.45, P<.02) were significantly associated with mortality in GMU. Conclusion: This study demonstrated that patients with HIV/AIDS or tuberculosis, non malignant digestive diseases or FS had a better outcome. However those with impairment of renal and liver functions had a high risk of death in the GMU.