{"title":"埃塞俄比亚肝硬化患者院内死亡率的预测因素:多中心回顾性研究","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":"{\"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}","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
摘要
摘要背景:肝硬化是一个重大的全球性健康问题,也是导致肝脏相关疾病死亡的主要原因。然而,到目前为止,人们对影响肝硬化并发症住院患者院内死亡率的因素还知之甚少。本研究评估了埃塞俄比亚肝硬化患者院内死亡率的预测因素:这是一项回顾性横断面研究,使用的数据来自 2023 年 1 月 1 日至 2024 年 3 月 31 日期间阿德拉医疗中心、圣保罗医院千禧医学院和提库尔安贝萨专科医院内科病房因肝硬化并发症住院患者的电子病历。使用频率和交叉表进行描述性统计。双变量分析中 p 值为 0.25 的预测变量被纳入逻辑回归。计算调整后的几率比(AOR)及相应的 95% 置信区间(CI),以显示相关性的强度。P值为0.05即为具有统计学意义:在纳入最终分析的 299 名患者中,大多数(79.6%)为男性,研究参与者的平均年龄为 45(IQR,36-56)岁。乙型肝炎病毒(32.1%)是最常见的病因,其次是酒精(30.1%)和丙型肝炎病毒(13.4%)。半数以上(52.9%)的患者属于 Child-Pugh C 级,约四分之一(26.1%)的患者有并发症。腹水(69.2%)、上消化道出血(50.5%)和肝性脑病(44.8%)是最常见的表现形式。院内死亡率为 25.4%。WestHaven III 级或 IV 级肝性脑病(AOR:12.0;95% CI 2.33 - 61.63;P <0.01)、肝细胞癌(AOR:9.05;95% CI 2.18 - 37.14;P:0.01)、一年内有入院史(AOR:6.80;95% CI 2.18 - 21.18;P <0.01)、急性肾损伤(AOR:6.47;95% CI 1.77 - 23.64;P <0.01)和终末期肝病模型-钠(MELD-Na)评分(AOR:1.17;95% CI 1.05 - 1.30;P:0.02)被认为是院内死亡率的预测因素:结论:在埃塞俄比亚,肝硬化患者的院内死亡率很高。西黑文 III 级或 IV 级肝性脑病是死亡的主要原因。因此,在早期阶段及时发现和处理肝性脑病及其诱发因素对于改善治疗效果和提高存活率至关重要:肝硬化 院内死亡率 埃塞俄比亚
Predictors of In-hospital Mortality among Cirrhotic Patients in Ethiopia: A Multicenter Retrospective Study
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