Predictors of In-hospital Mortality among Cirrhotic Patients in Ethiopia: A Multicenter Retrospective Study

Abstract

Background Cirrhosis is a major global health problem and a leading cause of liver-related mortality. In Ethiopia specifically, cirrhosis is the 6th leading cause of death and is responsible for high hospitalization and mortality rates. However, until now, factors affecting in-hospital mortality in patients admitted due to complications of liver cirrhosis are poorly understood. This study assessed the predictors of in-hospital mortality among cirrhotic patients in Ethiopia. Methods A retrospective cross-sectional study using data collected from the electronic medical records of patients who were admitted for complications of liver cirrhosis between January 1, 2023, and March 31, 2024, in the medical wards of Adera Medical Center, St. Paul’s Hospital Millennium Medical College, and Tikur Anbessa Specialized Hospital. Frequency and cross-tabulation were used for descriptive statistics. Predictor variables with a p-value < 0.25 in bivariate analyses were included in the logistic regression. The adjusted odds ratio (AOR) with the corresponding 95% confidence interval (CI) was calculated to show the strength of the association. A p-value < 0.05 was considered statistically significant. Results Of the 299 patients included in the final analysis, the majority (79.6%) were males, and the median age of the study participants was 45 (IQR, 36–56) years. Hepatitis B virus (32.1%) was the most common etiology, followed by alcohol (30.1%) and hepatitis C virus (13.4%). More than half (52.9%) of the patients were in Child-Pugh class C, and around a quarter (26.1%) of the patients had comorbidities. Ascites (69.2%), Upper gastrointestinal bleeding (50.5%), and hepatic encephalopathy (44.8%) were the most common forms of presentation. The in-hospital mortality rate was 25.4%. West Haven Grade III or IV hepatic encephalopathy (AOR: 12.0; 95% CI 2.33–61.63; P < 0.01), Hepatocellular Carcinoma (AOR: 9.05; 95% CI 2.18–37.14; P: 0.01), History of previous admission within one year period (AOR: 6.80; 95% CI 2.18–21.18; P < 0.01), Acute Kidney Injury (AOR: 6.47; 95% CI 1.77–23.64; P < 0.01), and Model for End-Stage Liver Disease – Sodium (MELD-Na) Score (AOR: 1.17; 95% CI 1.05–1.30; P: 0.02), were found to be predictors of in-hospital mortality. Conclusion In-hospital mortality of cirrhotic patients is high in Ethiopia. West Haven grade III or IV hepatic encephalopathy is the leading cause of mortality. Hence, Prompt identification and management of hepatic encephalopathy and its precipitant at an earlier stage is crucial for better treatment outcomes and survival.