Economic Impact of Alcoholic Cirrhosis and Its Disability Adjusted Life Years

Abstract

© 2011, INASL 19 Prevalence of Infection Among Patients of Chronic Parenchymal Liver Disease and Its Sensitivity Pattern S Shetty, R Kothari, D Prasanna, M Pazhanivel Department of Gastroenterology, PSG IMS and R, Coimbatore Background: Bacterial infection is a frequent complication in patients with chronic liver disease. Infection can prove fatal, either directly or by precipitating encephalopathy, gastrointestinal hemorrhage or renal failure. Often, recognition of infection is made difficult by absence of clinical features like fever, hypotension or leukocytosis. Therefore, early identification, by means of culture of body fluids, will reduce hospital stay, morbidity and mortality in chronic liver disease patients. Aim: To determine the prevalence of infections in cirrhotic patients and to study their sensitivity pattern. Methods: Cirrhotic patients admitted over the last 3 months, who had not received antimicrobial therapy in the previous 7 days, were included. Blood, urine and ascitic fluid cultures were performed on the day of admission. Results: Of the 41 patients included in the study group, 21 (51%) were found to have culture positive infection. Among these, 6 patients had polymicrobial infection. One patient was found to have fungal infection. A total of 28 organisms were cultured, of which 16 (57%) were found to be resistant to the commonly used antibiotics, i.e. 3rd generation cephalosporins and fluoroquinolones. Table Prevalence of infection Microorganism Sensitive Resistant Escherichia coli (ESBL) 4 8 Staphylococcus 2 2 Citrobacter freundii 0 1 Klebsiella pneumoniae 1 1 Streptococcus 0 1 Acinetobacter baumannii 2 0 Enterococcus faecalis 1 3 Gram negative bacilli 2 0 Conclusion: The present study shows a high prevalence of bacterial infections among patients of chronic parenchymal liver disease. Also, a majority of these infections are by drug-resistant strains, which further increases cost of treatment. Conflict of Interest: None Economic Impact of Alcoholic Cirrhosis and Its Disability Adjusted Life Years Shareej*, AR Rajneesh*, B George#, TM Ramachandran†, T Varghese‡ *Senior Resident, #Assistant Professor, Department of Community Medicine, †Additional Professor of Gastroenterology ‡Professor and Head of Department of Gastroenterology Background: Alcohol abuse and related disorders are on the rise recently so also related complications. Society is spending huge amount of money to treat these preventable diseases. Kerala has the highest per capita alcohol consumption in India. Aim: To analyze the average cost of treatment and disability adjusted life years of alcohol-related cirrhosis. Method: This prospective analytical study was done over a period of 1 year from January 2010 to December 2010 by interviewing patients with alcoholic cirrhosis, their relatives and friends. Results: Total number 111. Mean age 45.29. The average family income was Rs. 5902.2 ± 4099. 101 (90.9%) patients were the sole bread winner of the family. Educational status of patients were primary 15 (13.5%), middle 26 (23.4%), secondary 34 (30.6%), higher secondary 16 (14.4%), college 14 (12.6%), and professionals 6 (5.40%). Ninety eight (88.3%) patients consumed alcohol daily. Eighty two (73.9%) consumed bandy, 69 (62.2%) whiskey, 54 (48.6%) beer, 50 (45%) rum, 10 (9%) gin, 1 (0.9%) wine, 37 (33%), illicit arrack 39 (35%) toddy and majority were consuming more than two types. Mean duration of alcohol consumption was 20.72 years and daily intake 116.48 g. Mean age of beginning of regular consumption 22.51. 70% of daily income was spent for alcohol by the low income group and 50% by the middle income group. Mean age of detection of cirrhosis 42.69. Mean MELD score 17.5 ± 6.3. Mean no. of hospital admission was 4.80 ± 3.8. Mean duration of hospital stay was 8.91 ± 5.7 days. Mean no. of OPD visits was 8.78. Mean hospital expenses were Rs. 8769.37, for liver related drugs 4410, day to day expenses 13841, and procedure expenses 2407.8. There were 16 deaths in the study 03_JCEH-Abstract.indd 19 3/18/2011 11:13:04 AM