Mortality Factors for Cirrhotics in an Ivorian University Hospital (Ivory Coast)

Abstract

Background: Cirrhosis, an ineluctable development of chronic liver disease, still has high mortality throughout the world despite many advances in physiopathology and therapy. This high mortality is closely related to the unpredictable course of cirrhosis with numerous complications. Objective: To evaluate the predictive factors of death during cirrhosis. Materials and methods: This is an observational, descriptive study on cirrhotic patients hospitalized in the hepatology unit of the Center Hospitalier Universitaire in Bouake (Ivory Coast) during the period from January 01, 2018 to December 31, 2019. The study focused on the data collected in the medical files (paper format) of hospitalized cirrhotics and the death register of the service. The diagnosis of cirrhosis and the death of the cirrhotic were the main criteria for judgment. The secondary criteria defined were: history of cirrhosis, reasons for consultation, clinical signs, biological signs, complications of cirrhosis and the treatment received. The relationship between the parameters was expressed as an odds ratio (OR) with a 95% confidence interval (CI) and the significance threshold fixed at p < 0.05. Results: The study retained 206 files of cirrhotics including 146 men and 60 women. The hospital prevalence of cirrhosis was 44.17% and the mortality rate was 42.23%. The deceased patients were mainly men with an average age of 49 years. The etiologies of cirrhosis were dominated by viral hepatitis B, chronic alcohol poisoning and viral hepatitis C, respectively 46.95%, 37.35% and 10.84%. The predictors of death were: the presence of icterus (OR = 1.89, 95%CI [1.08 - 3.30], p = 0.036), hepatic encephalopathy (OR = 8.75, 95%CI [4.51 - 16.94], p < 0.001) and hepatocellular carcinoma (OR = 2.23, 95%CI [1.25 - 3.98], p = 0.010); the presence in the biology of hepatic cytolysis (OR = 2.57, 95%CI [1.35 - 4.89], p = 0.006), severe hepatocellular insufficiency (OR = 2.57, 95%CI [1.38 - 4.77], p = 0.004), severe renal insufficiency (OR = 2.41, 95%CI [1.09 - 5.32], p = 0.044) and hyperleukocytosis (OR = 2.28, 95%CI [1.29 - 4.04], p = 0.007); Child-Pugh stage C (OR = 19.64, 95%CI [9.02 - 42.74], p < 0.001); the presence on ultrasound of large liver and variable nodules (OR = 4.16, 95%CI [2.02 - 8.58], p < 0.001). Conclusion: Cirrhosis is a public health problem at the Bouake university hospiler center. Decompensated and complicated old cirrhosis, hepatic cytolysis, severe hepatocellular insufficiency, severe renal insufficiency and hyperleukocytosis, heterogeneous nodular large liver are the detrimental factors.