Abstract
Intra-hospital mortality in cirrhotic patients is variable depending on the studies reported in literature. 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 sociodemographic 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/mm3), 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.
Highlights
The search for risk factors that stratify cirrhotic patients into subgroups with different survival rates is of great prognostic value for the clinician
The statistical accuracy of the Child-Pugh score (CPS) was not assessed, it was long considered to be an adequate method to determine the degree of liver failure, and the probability of survival [13]-[15]
Complications of cirrhosis were analyzed in univariate analysis (Table 5), and significant associations with mortality were objectified for jaundice, ascites (p = 0.001), hemorrhagic decompensation, hepatic encephalopathy and spontaneous bacterial peritonitis (p < 0.0001)
Summary
The search for risk factors that stratify cirrhotic patients into subgroups with different survival rates is of great prognostic value for the clinician. Many studies have focused on the search for predictors of mortality in cirrhotic patients, and their use to develop a reliable model of survival. In these studies, the study populations were cirrhotic patients [1]-[5], patients with alcoholic cirrhosis [6] [7], and cirrhotic patients after an episode of variceal bleeding [8]-[12]. The principal etiology of cirrhosis in our patients is hepatitis B and C It seemed, interesting to investigate the factors involved in the short-term survival in these cirrhotic patients
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