Short term Outcomes of Patients with Decompensated Cirrhosis on Follow up at Tikur Anbessa Specialized Hospital: a 1-year Retrospective Cohort Study
No Thumbnail Available
Date
2021
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Addis Abeba University
Abstract
Background: Cirrhosis is the leading cause of liver-related death globally with the highest age
standardized death rates recorded in low income countries in the Sub-Saharan Africa region.
Studies that assess the short and long term outcomes of patients with chronic liver diseases in
general and decompensated cirrhosis, in particular, are limited in Ethiopia.
Objectives: This study was conducted to assess the short term outcomes of patients with
decompensated cirrhosis at Tikur Anbessa Specialized Hospital (TASH) within 06 months of their
index hospital visit/ admission, and to explore the prevalence and factors associated with poor
outcome among these patient groups. It also assessed the demographic and clinical characteristics
as well as the commonest etiologic causes of cirrhosis among the study participants.
Methods: A single center, 1year retrospective cohort study was conducted including data from
medical records of patients with decompensated cirrhosis who were admitted at the emergency
department (ED), intensive care unit (ICU), or medical wards, or were seen as an outpatient at the
Gastroenterology (GI) clinic at TASH from March 2020 to March 2021. Chi-square statistics and
binary logistic regression were used to examine the presence and strength of association between
categorical variables, and the Cox proportional hazard model was used to test the probability of
occurrence of poor outcome among the study participants. The statistical significance was set at
P< 0.05.
Results: Among 110 participants in this study 82(74.5%) were male. The mean age (± SD) of the
participants was 40.35 (± 13.5) years and the median duration of known chronic liver disease was
20.5months (IQR 33). Chronic hepatitis B infection (46.36%) was the commonest identified
etiology of cirrhosis followed by alcohol related cirrhosis and cryptogenic cirrhosis in 24.55%
20.9% participants respectively. Sixty one hospital admissions were documented during the study
period, with 49(44.5%) participants having been admitted at index hospital visit. Upper GI
bleeding, hepatic encephalopathy, and hepatocellular carcinoma were the most common reasons
for hospitalization at all time points in the study. A total of 16(14.54%) participants died in the
hospital during the study period. Chronic HBV infection was found to contribute significantly to
overall poor outcomes [AOR=4.4; 95%CI: 1.15-16.93]. A statistically significant association was
found between age above 40years and the development of upper GI bleeding after adjustment for
other variables, but not with other complications of portal hypertension [AOR=2.8; 95%CI: 0.765.44].
However, sex, other etiologies of cirrhosis, Child Pugh score at index hospital visit/
admission and renal function were not found to be associated with poor outcome measures during
the study period, (p>0.05).
Conclusion: Chronic HBV infection was the commonest etiology and a strong predictor of overall
poor outcome, whereas age above 40 years was a significant contributor to the development of
upper GI bleeding. Hepatic encephalopathy and upper GI bleeding were predictors of
hospitalization.
Description
Keywords
Decompensated cirrhosis, End stage liver failure, Chronic liver disease