Factors Associated with in-Hospital Mortality in Malagasy Patients with Acute Decompensation of Liver Cirrhosis: A Retrospective Cohort (original) (raw)
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In Hospital Mortality Related to Cirrhosis of Liver in a Tertiary Care Rural Hospital
The objective of the study was to identify the causes of mortality among the hospitalsed patients with decompensated cirrhosis of liver and to evaluate for the biochemical and hematological parameters that are related to mortality during hospitalization. Total number of cases are 70 and number of controls are 70. Both cases and controls were compared and found to be age and sex matched. . The Mean age of cases is 46.33 years and the mean age of controls is 45.56 years. The Child-Pugh, MELD and MELD Na scores were computed for each patient on admission. Both cases and control groups contained predominantly male patients, 91.4% and 94.3% respectively. The most common cause of liver dysfunction was found to be alcohol related. The most common cause of admission was hepatic encephalopathy in both groups. The other reasons for admission are renal insufficiency, refractory ascites, upper gastrointestinal bleeding. While evaluating for Chlid status in both groups, 11.4 % of patients in both groups had Child's A cirrhosis. 48.6% of cases had Child's B cirrhosis while 52.9% of controls had Child's B cirrhosis. 40.0% cases and 35.7% controls had Child's C cirrhosis. The mean MELD and MELD-Na was significantly higher for the cases group compared to the control group i.e 24.47 & 18.4 for MELD and 29.10 & 23.54 for MELD-Na for the cases and controls respectively. The most common causes of death are due to cirrhosis related complications associated with decompensation like hepatic encephalopathy, hepato renal syndrome and upper gastrointestinal bleeding. A small number of patients died due to non cirrhosis related complications most commonly infections. Univariate analysis was performed on all variables. A p value less than 0.05 was considered statistically significant. This analysis revealed that increasing levels of MELD, MELD-Na, serum creatinine, INR, WBC, neutrophilia and duration of disease were significantly associated with increased risk of death. On multivariate forward stepwise logistic regression, an elevated WBC count (p=0.02, OR 1.2) and creatinine (p=0.003, OR 1.2) were the only factors significantly associated with death. In this study, in hospital mortality in cirrhosis is predominantly due to hepatic dysfunction. The most common cause of mortality in decompensated cirrhosis is due to hepatic encephalopathy, hepato renal syndrome and upper gastro intestinal bleeding. Patients who had died also exhibited higher MELD and MELD sodium value levels. Therefore, when patients are admitted with hepatic decompensation, clinical parameter like duration of disease, hematological parameters like leukocyte count and neutrophilia, biochemical parameters like creatinine, SGPT and INR can help predict short term or in hospital mortality along with MELD and MELD sodium. In this study, Child score did not help in predicting short term mortality in hospitalized patients.
PLOS ONE, 2021
Background Chronic liver diseases including liver cirrhosis are a major cause of morbidity and mortality globally. Despite the high burden of liver cirrhosis in Ghana, data on this disease is lacking. Objective To determine the sociodemographic characteristics, reasons for admission, and in-hospital mortality of patients with cirrhosis of the liver seen at a district hospital in Ghana. Methods A prospective study was conducted involving one hundred and eighty-six (186) patients admitted on the medical wards in St. Dominic hospital with liver cirrhosis from 1st January 2018 to 24th June 2020. The patient’s demographic and clinical features were documented using a standardized questionnaire. Diagnostic biochemical and haematological tests as well as abdominal ultrasound scans were performed for all patients. They were followed up until death or discharge from hospital. Results One hundred and eighty-six patients (186) with a median age of 46 years were included in the study. HBV was t...
Predictors of Intra-Hospital Mortality in Patients with Cirrhosis
Open Journal of Gastroenterology, 2014
rature. Several studies have demonstrated independent predictors of mortality. The aim of this work is indeed to identify these predictors. Patients and Methods: We conducted a retrospective study of 1080 cirrhotic patients hospitalized in our department of gastroenterology and hepatology between January 2001 and August 2010. A descriptive study of the study population was performed, and a univariate analysis looking for an association between intra-hospital mortality, and clinical, biological, etiological and socio-demographic characteristics of our patients. Results: The average age of our patients was 54 years, with an equal number of men and women. 41.1% of patients had cirrhosis secondary to hepatitis C and 18.5% had cirrhosis secondary to hepatitis B. 26.1% of our patients were CHILD C. Intra-hospital mortality was 8.7% (97 deaths) with a mean of 23.4 ± 35.8 months. Univariate analysis showed that the intra-hospital mortality was significantly associated with higher age (p = 0.049) as well as the reasons for admissions like hepatic encephalopathy, and hematemesis (p < 0.0001), melena, jaundice and ascites (p = 0.001). Among the biological parameters analyzed in univariate analysis, significant associations with mortality were objectified for high white blood cell count (p = 0.035), and high serum bilirubin and creatinine (p < 0.0001); low rate of prothrombin time (PT) (p < 0.0001), of albumin (p = 0.0001) and of serum sodium (p < 0.0001). Among the complications analyzed, significant associations with mortality were objectified for jaundice, ascites (p = 0.001), hemorrhagic decompensation, hepatic encephalopathy, and spontaneous bacterial peritonitis (p < 0.001). Univariate analysis of the etiology of cirrhosis objectified significant associations for cirrhosis secondary to hepatitis B (p = 0.001) and hepatitis C (p = 0.022). Multivariate analysis objectified four independent predictors of mortality: hepatic encephalopathy, infection (hyper leukocytosis ≥ 10,000/mm 3 ), renal failure (serum creatinine ≥ 15 mg/l) and hyponatremia. Conclusion: In our series, we identified four independent predictors of intra-hospital mortality in cirrhotic patients: hepatic encephalopathy, infection, renal failure and hyponatremia.
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy, 2021
Background: liver cirrhosis is a global health problem. The mortality rate due to cirrhosis was estimated to achieve 1 million per year worldwide. The aim of this study is to elaborate the characteristics of patients with liver cirrhosis and factors affecting mortality during hospitalization in Fatmawati General Hospital.Method: The design of this study was retrospective cohort involving patients admitted to the hospital between January and March 2019.Results: Among 41 liver cirrhosis patients, it was found that the average age was 52.9 ±13.8 years old and the percentage of male patients among participants was 75.6%. Patients who died during hospitalization was 12.2%. The average length of stay in hospital was 10.8±6.4 days. Patients were admitted to the hospital with various complaints; the most common complaint was gastrointestinal bleeding in 46.3%, decreased consciousness in 22% and massive ascites in 17.1% patients. Physical examination findings of anaemic conjunctiva, icteric...
Journal of emergency medicine, trauma and acute care, 2016
Background and study aims: Prognosis for patients with cirrhosis admitted to a medical intensive care unit (MICU) is poor and no previous studies have been published from Qatar or other countries in the region to investigate this issue. The objective of this study was to assess the predictors for in-hospital mortality and admission of cirrhotic patients to MICU in a single tertiary hospital in Qatar. Patients and methods: All adult cirrhotic MICU patients hospitalized from 2007 through 2012 to Hamad General Hospital-Qatar were included. We compared them to cirrhotic patients admitted to medical wards during same period of time. All data were recorded and analyzed with respect to demographic parameters, clinical features and laboratory as well as radiology characteristics on day one of admission to MICU. Cirrhosis diagnosis was established either with a liver biopsy or the combination of physical, laboratory and radiologic findings. Predictors of mortality were defined by logistic regression analysis. Results: The cohort comprised 109 cirrhotic MICU patients (86.2% males), and their mean age ± SD was 51.6 ± 11.5. MICU-cirrhotic patients had longer hospital stays than medical wards-cirrhotic patients (p = 0.01). Admission with severe hepatic encephalopathy, upper gastrointestinal bleeding and SOFA (Sepsis Related Organ Failure Assessment) score were the independent predicting factors for MICU admission. Mortality was higher for the MICU-cirrhotic group than medical wards group (27 (24.8%) deaths vs. 12 (5.3%) deaths, respectively, p = 0.001). In multivariate logistic regression analyses, older age > 60 years (p = 0.04), APACH-II score (p = 0.001) and MELD score (p = 0.02) were independent predicting factors for overall mortality. Conclusion: Severe hepatic encephalopathy, upper gastrointestinal bleeding and SOFA score predict MICU admission of cirrhotic patients. Among MICU cirrhotic patients, older age, APACH-II score and MELD score predict mortality.
Decompensated liver cirrhosis: assessment of complications and mortality in hospitalised patients
Gastroenterologìa/Gastroenterologìâ, 2024
Background. Liver cirrhosis is a severe, progressively fatal disease if untreated. Hospitalised patients face high mortality rates, and current methods for assessing prognosis vary widely. The research aims to investigate complications and predictors of mortality in patients admitted for decompensated cirrhosis to a tertiary care centre in Tirana, Albania. Materials and methods. The retrospective study included 212 patients aged (58.67 ± 10.09) years: 174 (82.1 %) men, 38 (17.9 %) women. The Child-Turcotte-Pugh, MELD, MELD-Na, MELD 3.0, iMELD, MESO, and UKELD scales were used to assess the severity of the condition and risk stratification of patients. The number of patients with a fatal outcome was 43 (20.3 %). Results. Among participants with different etiological factors of liver cirrhosis, the mortality rate did not differ significantly (p = 0.873). The presence of hepatic encephalopathy (0.43; p = 0.001), acute-on-chronic liver failure (r = 0.47; p = 0.001) and hepatorenal syndrome (r = 0.49; p = 0.001), and, to a lesser extent, ascites (r = 0.18; p = 0.006) and spontaneous bacterial peritonitis (r = 0.23; p = 0.041) was a marker of unfavourable prognosis of hospitalisation. Also, the risk of death increased in the presence of leukaemia (hazard ratio = 4.21 (1.65; 10.74); p = 0.003). Conclusions. The MELD 3.0 and MELD-Na scores, calculated based on laboratory values obtained within 48-72 hours of hospitalisation, were found to be the prognostically significant (p < 0.05).
Factors affecting the outcome of hospitalization among liver cirrhosis patients
Pakistan Journal of Medical Sciences, 2019
Objectives: To determine the factors affecting the outcome of hospitalization in patients suffering liver cirrhosis hospitalized to tertiary care hospital, Gujranwala, Pakistan. Methods: After informed consent, the data of liver cirrhosis patients with age >12 years hospitalized from June 2016 to May 2017 was collected by purposive sampling. The outcome of the hospitalization in term of ‘death’ and ‘no death’ was noted. Statistical analysis was done using SPSS version 25. Bivariate analysis as well binary logistic regression was performed to ascertain the effect of different predictors like gender, age, history of diabetes mellitus, etiology of cirrhosis, presence of hepatic encephalopathy at presentation, presence of upper GI bleed, and tracheobronchial aspiration on the likelihood that death would be the outcome in liver cirrhosis patients. Results: Amongst total of 1304 patients, 15.7% died during hospitalization. The mean age of those who died was 58.08 + 14.49 years. Bivaria...
Arab Journal of Gastroenterology, 2016
Background and study aims: Prognosis for patients with cirrhosis admitted to a medical intensive care unit (MICU) is poor and no previous studies have been published from Qatar or other countries in the region to investigate this issue. The objective of this study was to assess the predictors for in-hospital mortality and admission of cirrhotic patients to MICU in a single tertiary hospital in Qatar. Patients and methods: All adult cirrhotic MICU patients hospitalized from 2007 through 2012 to Hamad General Hospital-Qatar were included. We compared them to cirrhotic patients admitted to medical wards during same period of time. All data were recorded and analyzed with respect to demographic parameters, clinical features and laboratory as well as radiology characteristics on day one of admission to MICU. Cirrhosis diagnosis was established either with a liver biopsy or the combination of physical, laboratory and radiologic findings. Predictors of mortality were defined by logistic regression analysis. Results: The cohort comprised 109 cirrhotic MICU patients (86.2% males), and their mean age ± SD was 51.6 ± 11.5. MICU-cirrhotic patients had longer hospital stays than medical wards-cirrhotic patients (p = 0.01). Admission with severe hepatic encephalopathy, upper gastrointestinal bleeding and SOFA (Sepsis Related Organ Failure Assessment) score were the independent predicting factors for MICU admission. Mortality was higher for the MICU-cirrhotic group than medical wards group (27 (24.8%) deaths vs. 12 (5.3%) deaths, respectively, p = 0.001). In multivariate logistic regression analyses, older age > 60 years (p = 0.04), APACH-II score (p = 0.001) and MELD score (p = 0.02) were independent predicting factors for overall mortality. Conclusion: Severe hepatic encephalopathy, upper gastrointestinal bleeding and SOFA score predict MICU admission of cirrhotic patients. Among MICU cirrhotic patients, older age, APACH-II score and MELD score predict mortality.
Factors affecting mortality and resource use for hospitalized patients with cirrhosis
Medicine
Hospitalizations for advanced liver disease are costly and associated with significant mortality. This population-based study aimed to evaluate factors associated with in-hospital mortality and resource use for the management of hospitalized patients with cirrhosis. Mortality records and resource utilization for 52,027 patients hospitalized with cirrhosis and/or complications of portal hypertension (ascites, hepatic encephalopathy, variceal bleeding, spontaneous bacterial peritonitis, or hepatorenal syndrome) were extracted from a nationally representative sample of Thai inpatients covered by Universal Coverage Scheme during 2009 to 2013. The rate of dying in the hospital increased steadily by 12% from 9.6% in 2009 to 10.8% in 2013 (P < .001). Complications of portal hypertension were independently associated with increased in-hospital mortality except for ascites. The highest independent risk for hospital death was seen with hepatorenal syndrome (odds ratio [OR], 5.04; 95% confidence interval [CI], 4.38-5.79). Mortality rate remained high in patients with infection, particularly septicemia (OR, 4.26; 95% CI, 4.0-4.54) and pneumonia (OR, 2.44; 95% CI, 2.18-2.73). Receiving upper endoscopy (OR, 0.29; 95% CI, 0.27-0.32) and paracentesis (OR, 0.93; 95% CI, 0.87-1.00) were associated with improved patient survival. The inflation-adjusted national annual costs (P = .06) and total hospital days (P = .07) for cirrhosis showed a trend toward increasing during the 5-year period. Renal dysfunction, infection, and sequelae of portal hypertension except for ascites were independently associated with increased resource utilization. Renal dysfunction, infection, and portal hypertension-related complications are the main factors affecting in-hospital mortality and resource utilization for hospitalized patients with cirrhosis. The early intervention for modifiable factors is an important step toward improving hospital outcomes.
Factors Influencing the Outcome of Hospitalization Among Patients with Liver Cirrhosis
2020
Objectives: To identify factors influencing the outcome of hospitalized patients with liver cirrhosis. Methods: Data of patients with cirrhosis aged> 12 years who were hospitalized were included after informed consent were collected using the method of purposive sampling. There was a hospitalization score for "death" and "non-death". Statistical analysis was performed with SPSS version 25. Two-dimensional analysis and binary logistic regression were performed to determine the influence of various prognostic factors such as gender, age, diabetes history, liver cirrhosis etiology, presence of hepatic encephalopathy at presentation, presence of the upper gastrointestinal tract tracheobronchial bleeding and aspiration on the likelihood of death in patients with cirrhosis of the liver. Results: Out of 1,304 patients, 15.7% died during hospitalization. The mean age of the deceased was 58.08 + 14.49 years. Two-dimensional analysis suggested that mortality was significantly higher in the group of patients with hepatic encephalopathy at presentation (p <0.01), without upper gastrointestinal bleeding (p <0.01). It was not significantly different between male / female genders (p = 0.504), diabetic / non-diabetic groups (p = 0.652), and viral / non-viral etiology of cirrhosis (p = 0.918). Binary logistic regression revealed that patients with tracheobronchial aspiration were 12.3 times more likely to die than patients without tracheobronchial aspiration. Similarly, in patients with hepatic encephalopathy, the likelihood of death was 7.862 times greater than in patients without hepatic encephalopathy. Conclusion: Hospital mortality among patients with cirrhosis was high. Age, sex, history of diabetes, viral etiology of cirrhosis did not significantly affect the mortality of these patients. Patients who developed hepatic encephalopathy and who experienced tracheobronchial aspiration during hospitalization had a higher risk of death. Excellence in treating hepatic encephalopathy and preventing aspiration can effectively reduce the mortality rate of patients with cirrhosis in our hospitals.