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

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.

Clinical Profile and Limitations in the Management of HBV Patients Attending Clinic at a District Hospital in Ghana

“…Although female participants in this study were more than males, more males presented with liver cirrhosis and HCC than females. This is comparable to other studies conducted in this country and other published studies from other countries [ 12 , 14 – 16 ]. Possible reasons for gender inequality of chronic liver disease include gender-specific lifestyle and involvement of activities that expose them to risk factors of chronic liver disease such as excessive alcohol consumption, smoking, intravenous drug abuse, poor dieting, and HBV or HCV.…”

“…HBV-infected patients are at increased risk of death from liver cirrhosis, hepatocellular carcinoma (HCC), and liver failure. In Ghana, HBV is the leading cause of liver cirrhosis and hepatocellular carcinoma, and this condition normally afflicts a younger population compared to Western counterparts, leading to mortality and its consequent economic hardship for families affected [ 12 – 15 ]. Although the majority of patients in this study presented with asymptomatic clinical features, a relatively high number (32.1%) reported late with liver-related complications (liver cirrhosis and hepatocellular carcinoma).…”

“…The most critical problem in the management of CHB in Africa including Ghana is the high cost of laboratory tests and drugs. One of the barriers identified in this country to HBV treatment is the high cost; however, this was based on qualitative studies [ 11 , 12 ]. Anecdotal evidence suggests that drugs for treatment may not be widely available, especially in district hospitals in Ghana and even if available may be too expensive for patients to buy.…”

A nationwide cross-sectional review of in-hospital hepatitis B virus testing and disease burden estimation in Ghana, 2016 - 2021

“…It is estimated that globally, over 1.3 million deaths in 2017 were because of liver cirrhosis alone. Studies in West Africa have shown that HBV accounts for 38-59% of cirrhosis and chronic liver disease cases [ 3 – 6 ]. The incidence of HCC continues to increase worldwide, and the highest rates of morbidity and mortality occur in sub-Saharan Africa [ 7 , 8 ], with HBV infection accounting for 55-70% of HCC cases in the region [ 3 , 9 ].…”

The Age, Gamma-Glutamyl Transpeptidase and Platelet Index: A Novel Noninvasive Model for Predicting Hepatocellular Carcinoma in Patients with Hepatitis B Virus-Related Liver Cirrhosis

“… 17 Data from West Africa showed that the sensitivity of APRI score >2 for diagnosis of cirrhosis was only 45.4%. 18 A high level of APRI was maintained in patients who developed HCC. 19 Nishikawa et al reported that FIB-4 rather than APRI could be a valuable predictor for HCC development in CHB patients undergoing entecavir treatment.…”