Predictive Scoring Systems for In-hospital Mortality Due to Acutely Decompensated Liver Cirrhosis in Indonesia

Overview

Journal BMC Gastroenterol

Publisher Biomed Central

Specialty Gastroenterology

Date 2021 Oct 21

PMID 34670501

Citations 1

Authors

Saut Horas H Nababan

Arif Mansjoer

Achmad Fauzi

Rino A Gani

Affiliations

Soon will be listed here.

Abstract

Background: Acutely decompensated liver cirrhosis is associated with high medical costs and negatively affects productivity and quality of life. Data on factors associated with in-hospital mortality due to acutely decompensated liver cirrhosis in Indonesia are scarce. This study aims to identify predictors of in-hospital mortality and develop predictive scoring systems for clinical application in acutely decompensated liver cirrhosis patients.

Methods: This was a retrospective cohort study using a hospital database of acutely decompensated liver cirrhosis data at Cipto Mangunkusumo National General Hospital, Jakarta (2016-2019). Bivariate and multivariate logistic regression analyses were performed to identify the predictors of in-hospital mortality. Two scoring systems were developed based on the identified predictors.

Results: A total of 241 patients were analysed; patients were predominantly male (74.3%), had hepatitis B (38.6%), and had Child-Pugh class B or C cirrhosis (40% and 38%, respectively). Gastrointestinal bleeding was observed in 171 patients (70.9%), and 29 patients (12.03%) died during hospitalization. The independent predictors of in-hospital mortality were age (adjusted OR: 1.09 [1.03-1.14]; p = 0.001), bacterial infection (adjusted OR: 6.25 [2.31-16.92]; p < 0.001), total bilirubin level (adjusted OR: 3.01 [1.85-4.89]; p < 0.001) and creatinine level (adjusted OR: 2.70 [1.20-6.05]; p = 0.016). The logistic and additive scoring systems, which were developed based on the identified predictors, had AUROC values of 0.899 and 0.868, respectively.

Conclusion: The in-hospital mortality rate of acutely decompensated liver cirrhosis in Indonesia is high. We have developed two predictive scoring systems for in-hospital mortality in acutely decompensated liver cirrhosis patients.

Citing Articles

A Novel Scoring System for Assessing In-Hospital Mortality Risk in Patients With Liver Cirrhosis.

Dewi N, Mariadi I, Pamungkas K, Dewi P, Dewi N, Sindhughosa D Cureus. 2024; 16(11):e72823.

PMID: 39618761 PMC: 11608421. DOI: 10.7759/cureus.72823.

References

Monescillo A, Martinez-Lagares F, Ruiz-Del-Arbol L, Sierra A, Guevara C, Jimenez E . Influence of portal hypertension and its early decompression by TIPS placement on the outcome of variceal bleeding. Hepatology. 2004; 40(4):793-801. DOI: 10.1002/hep.20386. View

Sarin S, Choudhury A, Sharma M, Maiwall R, Al Mahtab M, Rahman S . Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update. Hepatol Int. 2019; 13(4):353-390. PMC: 6728300. DOI: 10.1007/s12072-019-09946-3. View

Garcia-Pagan J, Caca K, Bureau C, Laleman W, Appenrodt B, Luca A . Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med. 2010; 362(25):2370-9. DOI: 10.1056/NEJMoa0910102. View

Vergara M, Cleries M, Vela E, Bustins M, Miquel M, Campo R . Hospital mortality over time in patients with specific complications of cirrhosis. Liver Int. 2013; 33(6):828-33. DOI: 10.1111/liv.12137. View

Irvine K, Ratnasekera I, Powell E, Hume D . Causes and Consequences of Innate Immune Dysfunction in Cirrhosis. Front Immunol. 2019; 10:293. PMC: 6401613. DOI: 10.3389/fimmu.2019.00293. View

Dionigi E, Garcovich M, Borzio M, Leandro G, Majumdar A, Tsami A . Bacterial Infections Change Natural History of Cirrhosis Irrespective of Liver Disease Severity. Am J Gastroenterol. 2017; 112(4):588-596. DOI: 10.1038/ajg.2017.19. View

Levesque E, Hoti E, Azoulay D, Ichai P, Habouchi H, Castaing D . Prospective evaluation of the prognostic scores for cirrhotic patients admitted to an intensive care unit. J Hepatol. 2011; 56(1):95-102. DOI: 10.1016/j.jhep.2011.06.024. View

Cavallazzi R, Awe O, Vasu T, Hirani A, Vaid U, Leiby B . Model for End-Stage Liver Disease score for predicting outcome in critically ill medical patients with liver cirrhosis. J Crit Care. 2012; 27(4):424.e1-6. DOI: 10.1016/j.jcrc.2011.11.014. View

Moreau R, Jalan R, Gines P, Pavesi M, Angeli P, Cordoba J . Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology. 2013; 144(7):1426-37, 1437.e1-9. DOI: 10.1053/j.gastro.2013.02.042. View

10.

. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392(10159):1736-1788. PMC: 6227606. DOI: 10.1016/S0140-6736(18)32203-7. View

11.

Jalan R, Fernandez J, Wiest R, Schnabl B, Moreau R, Angeli P . Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013. J Hepatol. 2014; 60(6):1310-24. DOI: 10.1016/j.jhep.2014.01.024. View

12.

Lopez-Velazquez J, Chavez-Tapia N, Ponciano-Rodriguez G, Sanchez-Valle V, Caldwell S, Uribe M . Bilirubin alone as a biomarker for short-term mortality in acute-on-chronic liver failure: an important prognostic indicator. Ann Hepatol. 2014; 13(1):98-104. View

13.

Carvalho G, Regis C, Kalil J, Cerqueira L, Barbosa D, Motta M . Causes of renal failure in patients with decompensated cirrhosis and its impact in hospital mortality. Ann Hepatol. 2011; 11(1):90-5. View

14.

Lazzarotto C, Ronsoni M, Fayad L, Lourenco Nogueira C, Bazzo M, Narciso-Schiavon J . Acute phase proteins for the diagnosis of bacterial infection and prediction of mortality in acute complications of cirrhosis. Ann Hepatol. 2013; 12(4):599-607. View

15.

Singal A, Salameh H, Kamath P . Prevalence and in-hospital mortality trends of infections among patients with cirrhosis: a nationwide study of hospitalised patients in the United States. Aliment Pharmacol Ther. 2014; 40(1):105-12. DOI: 10.1111/apt.12797. View

16.

. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018; 69(2):406-460. DOI: 10.1016/j.jhep.2018.03.024. View

17.

Li Y, Chaiteerakij R, Kwon J, Jang J, Lee H, Cha S . A model predicting short-term mortality in patients with advanced liver cirrhosis and concomitant infection. Medicine (Baltimore). 2018; 97(41):e12758. PMC: 6203558. DOI: 10.1097/MD.0000000000012758. View

18.

Agustina R, Dartanto T, Sitompul R, Susiloretni K, Suparmi , Achadi E . Universal health coverage in Indonesia: concept, progress, and challenges. Lancet. 2018; 393(10166):75-102. DOI: 10.1016/S0140-6736(18)31647-7. View

19.

Alsultan M, Alrshed R, Aljumah A, Baharoon S, Arabi Y, Aldawood A . In-hospital mortality among a cohort of cirrhotic patients admitted to a tertiary hospital. Saudi J Gastroenterol. 2011; 17(6):387-90. PMC: 3221112. DOI: 10.4103/1319-3767.87179. View

20.

Njei B, McCarty T, Laine L . Early transjugular intrahepatic portosystemic shunt in US patients hospitalized with acute esophageal variceal bleeding. J Gastroenterol Hepatol. 2016; 32(4):852-858. PMC: 5350067. DOI: 10.1111/jgh.13593. View