Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 27, 2018; 10(12): 944-955
Published online Dec 27, 2018. doi: 10.4254/wjh.v10.i12.944
Impact of sepsis and non-communicable diseases on prognostic models to predict the outcome of hospitalized chronic liver disease patients
Fakhar Ali Qazi Arisar, Shahab Abid, Preet Ayoub Shaikh, Safia Awan
Fakhar Ali Qazi Arisar, Shahab Abid, Preet Ayoub Shaikh, Safia Awan, Section of Gastroenterology, Department of Medicine, Faculty Offices Building, the Aga Khan University Hospital, Karachi 74800, Pakistan
Author contributions: Abid S contributed to the study idea and design; Qazi Arisar FA, Shaikh PA, Awan S, and Abid S contributed to acquisition, analysis, or interpretation of data; Qazi Arisar FA wrote the initial draft; Abid S and Shaikh PA made critical revision for important intellectual content; all authors approved the final version of the manuscript and are accountable for all aspects of the work.
Institutional review board statement: This study was reviewed and granted exemption by the Ethical Review Committee of the Aga Khan University Hospital, Karachi.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained through a retrospective review of charts.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Shahab Abid, FACG, FCPS, MD, PhD, Professor, Section of Gastroenterology, Department of Medicine, Faculty Offices Building, the Aga Khan University Hospital, Stadium Road PO Box 3500, Karachi 74800, Pakistan. shahab.abid@aku.edu
Telephone: +92-21-34864656 Fax: +92-21-34934294
Received: August 4, 2018
Peer-review started: August 6, 2018
First decision: August 24, 2018
Revised: September 7, 2018
Accepted: October 17, 2018
Article in press: October 18, 2018
Published online: December 27, 2018
Processing time: 145 Days and 13.7 Hours
Abstract
AIM

To evaluate the impact of sepsis and non-communicable diseases (NCDs) on the outcome of decompensated chronic liver disease (CLD) patients.

METHODS

In this cross-sectional study, medical records of patients with CLD admitted to the Gastroenterology unit at the Aga Khan University Hospital were reviewed. Patients older than 18 years with decompensation of CLD (i.e., jaundice, ascites, encephalopathy, and/or upper gastrointestinal bleed) as the primary reason for admission were included, while those who were admitted for reasons other than decompensation of CLD were excluded. Each patient was followed for 6 wk after index admission to assess mortality, prolonged hospital stay (> 5 d), and early readmission (within 7 d).

RESULTS

A total of 399 patients were enrolled. The mean age was 54.3 ± 11.7 years and 64.6% (n = 258) were male. Six-week mortality was 13% (n = 52). Prolonged hospital stay and readmission were present in 18% (n = 72) and 7% (n = 28) of patients, respectively. NCDs were found in 47.4% (n = 189) of patients. Acute kidney injury, sepsis, and non-ST elevation myocardial infarction were found in 41% (n = 165), 17.5% (n = 70), and 1.75% (n = 7) of patients, respectively. Upon multivariate analysis, acute kidney injury, non-ST elevation myocardial infarction, sepsis, and coagulopathy were found to be statistically significant predictors of mortality. While chronic kidney disease (CKD), low albumin, and high Model for End-Stage Liver Disease (MELD)-Na score were found to be statistically significant predictors of morbidity. Addition of sepsis in conventional MELD score predicted mortality even better than MELD-Na (area under receiver operating characteristic: 0.735 vs 0.686; P < 0.001). Among NCDs, CKD was found to increase morbidity independently.

CONCLUSION

Addition of sepsis improved the predictability of MELD score as a prognostic marker for mortality in patients with CLD. Presence of CKD increases the morbidity of patients with CLD.

Keywords: Chronic liver disease; Mortality; Morbidity; Prognostic factors; Non-communicable diseases; Sepsis

Core tip: Chronic liver disease is one of the leading causes of mortality. Child-Pugh and Model for End-Stage Liver Disease scores have been designed to predict the outcome in cirrhotic patients. Infection and renal insufficiency can worsen the outcome in cirrhotic patients. Myocardial infarction, sepsis,, and coagulopathy are associated with poor outcomes in patients with cirrhosis. The addition of sepsis can improve the predictability of the Model for End-Stage Liver Disease score as a prognostic marker for mortality in hospitalized patients with liver cirrhosis. Presence of chronic kidney disease increased the morbidity of cirrhotic patients. There is no direct impact of non-communicable disease over mortality in hospitalized patients with liver cirrhosis.