Prevalence, clinical characteristics and related mortality of cirrhosis in a tertiary hospital setting in Sub Saharan Africa

Abstract

Background: Published data on the prevalence and mortality associated to cirrhosis is rare in Cameroon. The aim of this study was to determine the prevalence, clinical and para clinical characteristics and associated mortality of cirrhosis at the Yaounde University Teaching Hospital (YUTH), Cameroon. Methods: Files of patient’s followed up or admitted for cirrhosis at the YUTH between June 1st 2016 and June 30th 2018 were reviewed. The diagnosis of cirrhosis was made based on clinical, biological, ultrasonographic and/or endoscopic signs of portal hypertension and chronic liver failure. In other to establish the cause of cirrhosis, markers of documented chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) was sought in the file of the patients and if not present, hepatitis C antibody and hepatitis B surface antigen testing were requested. In patients negative for HBV and HCV markers, alcohol intake was considered as a cause of cirrhosis in someone who have been consuming more than 30 g/day (for males) or more than 20 g/day (for females) of alcohol. Data analyses were performed using Epi info V 3.5.4. Results: During the period of study, 1748 patients were admitted in the internal medicine unit among which 117 had cirrhosis giving a prevalence of 6.7%. There were 67 males (57.3%) and 50 females (42.7%). The mean age of patients was 51 +/- 19.862 years. Patients with HCV related cirrhosis were older (mean age: 68years) than those with HBV induced cirrhosis (mean age: 38years). The most frequent signs were ascites 104 patients (88.9%), asthenia 92(78.6%), hepatomegaly 68(58.1%), jaundice 61(52.1%), abdominal distension 54(46.2%) and gastrointestinal bleeding 29(24.8%). Anaemia was present in 58 patients (49.6%), thrombocytopenia in 56 patients (47.9%), low prothrombine time in 64 patients (54.7%). Mean serum albumine was 27.59 g/l (6-70), mean total bilirubine 49.41mg/l (3-275mg/l), mean AFP 75693 mg/ml (0.8-1578022). Spontaneous bacterial peritonitis was found in 21 patients (17.9%) Performed in 30 patients (25.6%), upper digestive endoscopy showed oesophageal varices in 27 patients (90%), hypertensive gastropathy in 17 patients (56.7%) and an ulcer in 3 patients (10%). Found in 47 patients (40.2%), HBV infection was the most frequent cause of cirrhosis followed by chronic HCV infection in 43 cases (36.8%) and alcohol intake in 26 patients (22.2%). The most frequent Child-Pugh class was C in 32 patients (48.5%) followed by Child-Pugh B and A in 26 patients (39.4%) and 8 patients (12.1%) respectively. Mortality rate was estimated at 20.5% (24 patients) and death was attributed to hepatic encephalopathy in 19 patients, gastrointestinal bleeding in 3 patients and spontaneous bacterial peritonitis in 2 patients. Conclusion: Liver cirrhosis is frequent in our setting, mostly diagnosed on advanced stages with complications. The most common causes are viral hepatitis B and C. The mortality rate is high.