{"title":"Predictors of In-hospital Mortality among Cirrhotic Patients in Ethiopia: A Multicenter Retrospective Study","authors":"Tamrat Petros Elias, Abate Bane Shewaye, Henok Fisseha Chichaybelu, Abdulsemed Mohammed Nur, Kaleb Assefa Berhane, Asteray Tsige Minyilshewa, Kibrab Bulto Kumsa, Biruck Mohammed Seid","doi":"10.1101/2024.07.25.24311017","DOIUrl":null,"url":null,"abstract":"Abstract\nBackground: Cirrhosis is a major global health problem and a leading cause of liver-related mortality.\nIn Ethiopia specifically, cirrhosis is the 6th leading cause of death and is responsible for high\nhospitalization and mortality rates. However, until now, factors affecting in–hospital mortality in\npatients admitted due to complications of liver cirrhosis are poorly understood. This study assessed the\npredictors of in–hospital mortality among cirrhotic patients in Ethiopia.\nMethods: A retrospective cross–sectional study using data collected from the electronic medical\nrecords of patients who were admitted for complications of liver cirrhosis between January 1, 2023,\nand March 31, 2024, in the medical wards of Adera Medical Center, St. Pauls Hospital Millennium\nMedical College, and Tikur Anbessa Specialized Hospital. Frequency and cross-tabulation were used\nfor descriptive statistics. Predictor variables with a p-value <0.25 in bivariate analyses were included\nin the logistic regression. The adjusted odds ratio (AOR) with the corresponding 95% confidence\ninterval (CI) was calculated to show the strength of the association. A p-value <0.05 was considered\nstatistically significant.\nResults: Of the 299 patients included in the final analysis, the majority (79.6%) were males, and the\nmedian age of the study participants was 45 (IQR, 36–56) years. Hepatitis B virus (32.1%) was the\nmost common etiology, followed by alcohol (30.1%) and hepatitis C virus (13.4%). More than half\n(52.9%) of the patients were in Child-Pugh class C, and around a quarter (26.1%) of the patients had\ncomorbidities. Ascites (69.2%), Upper gastrointestinal bleeding (50.5%), and hepatic encephalopathy\n(44.8%) were the most common forms of presentation. The in–hospital mortality rate was 25.4%. West\nHaven Grade III or IV hepatic encephalopathy (AOR: 12.0; 95% CI 2.33 – 61.63; P <0.01),\nHepatocellular Carcinoma (AOR: 9.05; 95% CI 2.18 – 37.14; P: 0.01), History of previous admission\nwithin one year period (AOR: 6.80; 95% CI 2.18 – 21.18; P <0.01), Acute Kidney Injury (AOR: 6.47;\n95% CI 1.77 – 23.64; P <0.01), and Model for End–Stage Liver Disease– Sodium (MELD–Na) Score\n(AOR: 1.17; 95% CI 1.05 – 1.30; P: 0.02), were found to be predictors of in–hospital mortality.\nConclusion: In–hospital mortality of cirrhotic patients is high in Ethiopia. West Haven grade III or IV\nhepatic encephalopathy is the leading cause of mortality. Hence, Prompt identification and\nmanagement of hepatic encephalopathy and its precipitant at an earlier stage is crucial for better\ntreatment outcomes and survival.\nKeywords: Cirrhosis, In–hospital mortality, Ethiopia","PeriodicalId":501258,"journal":{"name":"medRxiv - Gastroenterology","volume":"42 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"medRxiv - Gastroenterology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1101/2024.07.25.24311017","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Abstract
Background: Cirrhosis is a major global health problem and a leading cause of liver-related mortality.
In Ethiopia specifically, cirrhosis is the 6th leading cause of death and is responsible for high
hospitalization and mortality rates. However, until now, factors affecting in–hospital mortality in
patients admitted due to complications of liver cirrhosis are poorly understood. This study assessed the
predictors of in–hospital mortality among cirrhotic patients in Ethiopia.
Methods: A retrospective cross–sectional study using data collected from the electronic medical
records of patients who were admitted for complications of liver cirrhosis between January 1, 2023,
and March 31, 2024, in the medical wards of Adera Medical Center, St. Pauls Hospital Millennium
Medical College, and Tikur Anbessa Specialized Hospital. Frequency and cross-tabulation were used
for descriptive statistics. Predictor variables with a p-value <0.25 in bivariate analyses were included
in the logistic regression. The adjusted odds ratio (AOR) with the corresponding 95% confidence
interval (CI) was calculated to show the strength of the association. A p-value <0.05 was considered
statistically significant.
Results: Of the 299 patients included in the final analysis, the majority (79.6%) were males, and the
median age of the study participants was 45 (IQR, 36–56) years. Hepatitis B virus (32.1%) was the
most common etiology, followed by alcohol (30.1%) and hepatitis C virus (13.4%). More than half
(52.9%) of the patients were in Child-Pugh class C, and around a quarter (26.1%) of the patients had
comorbidities. Ascites (69.2%), Upper gastrointestinal bleeding (50.5%), and hepatic encephalopathy
(44.8%) were the most common forms of presentation. The in–hospital mortality rate was 25.4%. West
Haven Grade III or IV hepatic encephalopathy (AOR: 12.0; 95% CI 2.33 – 61.63; P <0.01),
Hepatocellular Carcinoma (AOR: 9.05; 95% CI 2.18 – 37.14; P: 0.01), History of previous admission
within one year period (AOR: 6.80; 95% CI 2.18 – 21.18; P <0.01), Acute Kidney Injury (AOR: 6.47;
95% CI 1.77 – 23.64; P <0.01), and Model for End–Stage Liver Disease– Sodium (MELD–Na) Score
(AOR: 1.17; 95% CI 1.05 – 1.30; P: 0.02), were found to be predictors of in–hospital mortality.
Conclusion: In–hospital mortality of cirrhotic patients is high in Ethiopia. West Haven grade III or IV
hepatic encephalopathy is the leading cause of mortality. Hence, Prompt identification and
management of hepatic encephalopathy and its precipitant at an earlier stage is crucial for better
treatment outcomes and survival.
Keywords: Cirrhosis, In–hospital mortality, Ethiopia