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

Abstract

Background Chronic liver disease (CLD) is a progressive destruction of liver tissue with subsequent necrosis that persists for at least 6 months. In Ethiopia, despite the high burden report, data on CLD is limited. The objective of this study was to assess short-term clinical outcomes in patients admitted with chronic liver disease to three tertiary teaching hospitals in Ethiopia and to identify predictors of mortality. Methods A cohort of 109 patients admitted with CLD to three tertiary teaching hospitals in Ethiopia, were prospectively followed from the time of admission to 30-days of hospital discharge. The study was conducted from April 1, 2018, to October 5, 2018. Kaplan-Maier curve was used to estimate survival and cox-regression analysis to identify predictors of mortality. Result A total of 109 patients (80% male) diagnosed with CLD were included. Median age of the participants was 38(IQR, 30–48). The overall median length of hospital stay was 7(IQR, 4–11) days. Of the total, 39(35.8%) patients were HBsAg positive, and 12(11%) patients were anti-HCV positive. The 30-day mortality was 38(34.9%), and most of the deaths, 31(81.6%) occurred before hospital discharge. Hepatic encephalopathy at admission; being with unidentified risk factor/etiologies of CLD and total bilirubin level were independent predictors of in-hospital mortality. Patients with hepatic encephalopathy at admission had approximately 11 times increased risk of death as compared to patients without hepatic encephalopathy at admission. Similarly, the hazard of mortality was 5.8 times higher in those patients with unidentified risk factor/etiology as compared to others. The risk of dying had also increased with an increase in bilirubin (1.188[95% CI, 1.0719–1.316]) level. Conclusion Approximately one-quarter of patients with CLD died during their hospital stay, and the risk of death continued after hospital discharge. Hepatic encephalopathy at admission, unidentified risk factor/etiology and increased level of total bilirubin are poor prognostic factors. Given that more than one third the patients had HBV-infection, access to antiviral drugs could help improve the prognosis of patients with end-stage liver disease in Ethiopia, as well as prevent the progression of the disease if initiated earlier.

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

“…Hepatic encephalopathy (32.8%), ascites (20.4%), hepatocellular carcinoma (19.9%), and infections (18.8%) were prevalent in a large proportion of hospitalized patients. These are similar to other studies that have been conducted on this subject but in variable proportions [ 7 , 35 ]. Early identification of the following complications and their precipitating factors can help reduce the rate of admissions or death in these patients.…”

“…The male predominance of 2:1 reported in this study parallels that reported by Achinge et al in Nigeria [27]. Other reports from studies conducted in sub-Saharan Africa and other western countries have shown comparable male predominance [7,26]. A possible reason for this is that men are involved in events that exposes them to risk factors that causes…”

“…This is higher than 23.1% and 32.9% reported from previous studies conducted in a teaching hospital in Accra, Ghana [ 23 , 30 ]. A study by Terefe Tesfaye et al in Ethiopia [ 7 ], found HBV as the major cause of liver cirrhosis while in Sudan [ 31 ] alcohol abuse was the commonest cause. In Australia [ 32 ], alcohol was the commonest cause and in Greece [ 33 ] HCV was the major cause.…”

“…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.…”

“…In-hospital death in patients with liver cirrhosis and predictors of mortality are variable in various studies reported in literature. In a study conducted in Ethiopia by Terefe Tesfaye et al [ 7 ], in-hospital mortality of cirrhotic patients was found to be 28.4% with hepatic encephalopathy and high bilirubin as predictors of death. This study, however, was limited by the small sample size and inability to perform advanced images like CT scan and MRI.…”