Abstract
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. Bivariate analysis suggested that mortality was significantly higher in group of patients who had hepatic encephalopathy at presentation (p<0.01), no upper gi bleed (p<0.01), and who got tracheobronchial aspiration during hospitalization (p<0.01). It did not differ significantly in male/female gender (p=0.504), diabetic/non-diabetic groups (p=0.652), with viral/non-viral etiology of cirrhosis (p=0.918). Binary logistic regression revealed that patients who had tracheobronchial aspiration were 12.392 times more likely to die than who had no tracheobronchial aspiration. Similarly, patients who presented in hepatic encephalopathy were 7.862 times more likely to die than who presented without hepatic encephalopathy.Conclusion:The inpatient mortality rate amongst cirrhotic patients was high. Age, gender, history of diabetes, viral etiology of cirrhosis did not significantly contribute in the mortality of these patients. The patients who presented in hepatic encephalopathy, and who suffered tracheobronchial aspiration during hospitalization were more likely to die. Excellence in hepatic encephalopathy management and prevention from aspiration can effectively reduce the mortality rate of cirrhotic patients in our hospitals.
Highlights
Liver cirrhosis is an important public health issue in Pakistan.[1]
The mean age of the patients who died was 58.08 ± 14.49 years and the mean age of the patients who not died during hospitalization was 53.85 ± 14.19 years
The mean difference of the outcome of the hospitalization patient who was died and who survives due to liver cirrhosis is 4.23 and the comparison result is statistically significant (p
Summary
Liver cirrhosis is an important public health issue in Pakistan.[1] The HCV infections is the commonest etiology of liver cirrhosis in our country.[2] Its world-wide prevalence ranges from 4.5% to 9.5%.3. The reasons for hospitalization of cirrhotic patients include multiple complications of this disease, e.g. upper gastrointestinal bleed (UGIB)[4], hepatic encephalopathy (HE)[5] etc. Pak J Med Sci September - October 2019 Vol 35 No 5 www.pjms.org.pk 1382 of the hospitalization of these patients in term of recovery or death is unsatisfactory. In-hospital mortality among patients suffering liver cirrhosis is high world-wide, ranging from 13.5% to 35%.6,7. Till patient and hospital related factors affecting death rate or in-hospital mortality in admitted liver cirrhosis patients are poorly understood
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