Predictors of Intra-Hospital Mortality in Patients with Cirrhosis

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 socio-demographic 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/mm 3 ), 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.

Short-term clinical outcomes of patients admitted with chronic liver disease to selected teaching hospitals in Ethiopia

“…In the present study, the hazard of in-hospital mortality was found to increase by more than eleven-fold among patients with hepatic encephalopathy at admission as compared to those not diagnosed with hepatic encephalopathy In line with this, studies have shown an increase in the risk of mortality among patients with hepatic encephalopathy at presentation[36,37]. Hepatic encephalopathy is associated with poor outcomes with an overall decline in liver function, increased risk of in-hospital and short-term mortality[38,39,40].…”

Sociodemographic characteristics, complications requiring hospital admission and causes of in-hospital death in patients with liver cirrhosis admitted at a district hospital in Ghana

“…It also did not have access to endoscopy to diagnose oesophageal varices. A similar retrospective study conducted in Morocco by Charif et al [ 8 ], also found in-patients death of liver cirrhosis to be 8.7% with hepatic encephalopathy, hyponatremia, high creatinine, and leucocytes as predicting factors of death. Zubieta-Rodríguez et al [ 9 ], reported 23.5% in-hospital mortality with high MELD score, leucocyte count and low albumin as independent factors related to death in Columbia and in-hospital mortality rate in a study conducted in Saudi Arabia was 35% with advanced age and MELD scores as predictors of death [ 10 ].…”

“…Various studies have identified certain laboratory variables as independent risk factors for mortality in cirrhosis and these include white cell count, creatinine, albumin, bilirubin, prolonged INR, and infections [7,8,35,[37][38][39]. Mortality was highest in patients admitted with hepatic encephalopathy, sepsis, jaundice, and weight loss.…”

Clinical Characteristics of Liver Cirrhosis Patients in Internal Medicine Inpatient Ward of Fatmawati General Hospital and Factors Affecting Mortality during Hospitalization

“…6 Iliass Charif et al in Morocco found that the prevalence of mortality during hospitalization was slightly lower, which was 8.7%, In their study, it was stated that variceal bleeding, jaundice, ascites, and hepatic encephalopathy was significantly associated with mortality. 7 Gastrointestinal bleeding, hepatic encephalopathy, and ascites were signs of decompensated liver cirrhosis. These complications are closely associated with portal hypertension and, if they are not managed properly, they will have significant role in increasing mortality.…”