Short term Outcomes of Patients with Decompensated Cirrhosis on Follow up at Tikur Anbessa Specialized Hospital: a 1-Year Retrospective Cohort Study

Abstract

Background: Cirrhosis is the leading cause of liver-related mortality worldwide, with the highest age-standardized death rates found in low-income countries, particularly in Sub-Saharan Africa. In Ethiopia, studies evaluating the short-term outcomes of patients with chronic liver diseases, especially decompensated cirrhosis, are limited.

Objectives: This study aimed to assess the short-term outcomes of patients with decompensated cirrhosis at Tikur Anbessa Specialized Hospital and to identify the prevalence and factors associated with poor outcomes among these patients.

Methods: A retrospective cohort study was conducted over one year, including data from medical records of 110 patients with decompensated cirrhosis admitted to the emergency department, intensive care unit, medical wards, or seen as outpa tients at the Gastroenterology clinic from March 2020 to March 2021. Participants were selected consecutively using a convenience sampling technique. Chi-square statistics and binary logistic regression were employed to examine associations between categorical variables, while the Cox proportional hazard model assessed the probability of poor outcomes. Statistical significance was set at P < 0.05.

Results: Among the 110 participants, 82 (74.5%) were male, with a mean age of 40.35 (± 13.5) years. The median duration of known chronic liver disease was 20.5 months (IQR 33). Chronic hepatitis B infection was the most common etiology of cirrhosis (46.36%), followed by alcohol-related cirrhosis (24.55%) and cryptogenic cirrhosis (20.9%). The prevalence of poor outcomes—defined as readmission, variceal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis, and/or death—was 16.3%, 14.4%, and 22% at 1, 3, and 6 months, respectively. Sixty-one hospital admissions were documented, with 49 (44.5%) participants admitted at the index visit. Upper GI bleeding, hepatic encephalopathy, and hepatocellular carcinoma were the leading causes of hospitalization. During the study, 16 (14.54%) participants died in the hospital. Chronic HBV infection significantly contributed to poor outcomes [AOR=4.4; 95% CI: 1.15-16.93]. Age over 40 years was associated with upper GI bleeding [AOR=2.8; 95% CI: 0.76-5.44], but not with other complications of portal hypertension.

Conclusion: Chronic HBV infection was the predominant etiology of cirrhosis and a strong predictor of poor outcomes. Age over 40 was significantly linked to upper GI bleeding, while hepatic encephalopathy and upper GI bleeding predicted hospitalization. Enhancing access to HBV vaccines and treatments could improve overall prognosis. A national multicenter study is recommended to further investigate the outcomes of cirrhosis patients, focusing on specific causes and treatments to identify predictors of poor outcomes.

Keywords: Chronic liver disease, Decompensated cirrhosis