In Hospital Mortality Related to Cirrhosis of Liver in a Tertiary Care Rural Hospital
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2014, Vol 2, Issue 2
Abstract
The objective of the study was to identify the causes of mortality among the hospitalsed patients with decompensated cirrhosis of liver and to evaluate for the biochemical and hematological parameters that are related to mortality during hospitalization. Total number of cases are 70 and number of controls are 70. Both cases and controls were compared and found to be age and sex matched. . The Mean age of cases is 46.33 years and the mean age of controls is 45.56 years. The Child-Pugh, MELD and MELD Na scores were computed for each patient on admission. Both cases and control groups contained predominantly male patients, 91.4% and 94.3% respectively. The most common cause of liver dysfunction was found to be alcohol related. The most common cause of admission was hepatic encephalopathy in both groups. The other reasons for admission are renal insufficiency, refractory ascites, upper gastrointestinal bleeding. While evaluating for Chlid status in both groups, 11.4 % of patients in both groups had Child’s A cirrhosis. 48.6% of cases had Child’s B cirrhosis while 52.9% of controls had Child’s B cirrhosis. 40.0% cases and 35.7% controls had Child’s C cirrhosis. The mean MELD and MELD-Na was significantly higher for the cases group compared to the control group i.e 24.47 & 18.4 for MELD and 29.10 & 23.54 for MELD-Na for the cases and controls respectively. The most common causes of death are due to cirrhosis related complications associated with decompensation like hepatic encephalopathy, hepato renal syndrome and upper gastrointestinal bleeding. A small number of patients died due to non cirrhosis related complications most commonly infections. Univariate analysis was performed on all variables. A p value less than 0.05 was considered statistically significant. This analysis revealed that increasing levels of MELD, MELD- Na, serum creatinine, INR, WBC, neutrophilia and duration of disease were significantly associated with increased risk of death. On multivariate forward stepwise logistic regression, an elevated WBC count (p=0.02, OR 1.2) and creatinine (p=0.003, OR 1.2) were the only factors significantly associated with death. In this study, in hospital mortality in cirrhosis is predominantly due to hepatic dysfunction. The most common cause of mortality in decompensated cirrhosis is due to hepatic encephalopathy, hepato renal syndrome and upper gastro intestinal bleeding. Patients who had died also exhibited higher MELD and MELD sodium value levels. Therefore, when patients are admitted with hepatic decompensation, clinical parameter like duration of disease, hematological parameters like leukocyte count and neutrophilia, biochemical parameters like creatinine, SGPT and INR can help predict short term or in hospital mortality along with MELD and MELD sodium. In this study, Child score did not help in predicting short term mortality in hospitalized patients.
Authors and Affiliations
Shelly C Paul, Sridhar K, Srinivas MG, Harsha M, Harish Kumar Y, Mahaboob V Shaik, Thankappan KR
Keywords
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