Impact of sepsis and non-communicable diseases on prognostic models to predict the outcome of hospitalized chronic liver disease patients

Table 1 Baseline demographic details

Variables		n (%) or
		mean ± SD
Age (yr)		54.56 ± 11.74
Gender	Male	258 (64.6)
	Female	136 (34.4)
Etiology (viral)	Hepatitis C	260 (65.1)
	Hepatitis B	31 (7.7)
	Hepatitis B + Hepatitis D	12 (3)
	Hepatitis B + Hepatitis C	6 (1.5)
	Non-B, Non-C	61 (15.2)
	(Unknown etiology)
	Alcohol	20 (5)
	Autoimmune hepatitis	8 (2)
	Hemochromatosis	1 (0.25)
Duration of chronic liver disease (yr)		4.25 ± 3.71
NCDs	Diabetes	148 (37)
	Hypertension	96 (24)
	Chronic kidney disease	30 (7.5)
	Ischemic heart disease	23 (5.7)
	Chronic obstructive pulmonary disease	13 (3.2)
Infections on admission	Sepsis	70 (17.5)
	Lower respiratory tract infection	24 (6)
	Urinary tract infection	30 (7.5)
Non-ST Elevation myocardial infarction		7 (1.75)
Stroke		3 (0.75)
Decompensation on admission	Ascites	300 (75.1)
	Presence of esophageal/gastric varices	235 (58.8)
	Portosystemic encephalopathy	170 (42.6)
	Acute kidney injury	165 (41.3)
	Upper GI bleed	118 (29.5)
	Hepatocellular carcinoma	98 (24.5)
	Hepatorenal syndrome	86 (21.5)
	Spontaneous bacterial peritonitis	76 (19)
	Hepato-hydrothorax	12 (3)
Investigations	Hemoglobin (g/dL)	9.81 ± 2.17
	Total leukocyte count (× 109/L)	9.87 ± 6.17
	Platelets (× 109/L)	121.29 ± 108.12
	Prothrombin time (s)	17.37 ± 7.87
	International normalizing ratio	1.63 ± 0.65
	Creatinine (mg/dL)	1.65 ± 1.37
	Sodium (mmol/L)	132.3 ± 7.62
	Potassium (mmol/L)	4.17 ± 0.88
	pH	7.37 ± 0.12
	Bicarbonate (mmol/L)	20.13 ± 4.79
	Total bilirubin (mg/dL)	5.47 ± 7.57
	Alanine transaminase (IU/L)	78.7 ± 128.21
	Gama glutamyl transferase (IU/L)	119.26 ± 159.87
	Alkaline phosphatase (IU/L)	178.35 ± 133.8
	Albumin (g/dL)	2.59 ± 0.58
Child class	A	39 (9.8)
	B	142 (35.6)
	C	218 (54.6)
Prognostic scores	MELD score	18.0 ± 8.55
	MELD-Na	21.73 ± 8.31
	Charlson index	4.21 ± 1.63
	Charlson age adjusted score	5.33 ± 2.20
Outcomes	Mortality	52 (13)
	Prolong stay	72 (18)
	Readmission	28 (7)

NCDs: non-communicable diseases; GI: gastrointestinal; MELD: Model for End-Stage Liver Disease.

Table 2 Multivariate analysis of factors predicting 6 wk mortality in chronic liver disease patients

		OR (95%CI)	P value
NSTEMI	No	1
	Yes	16.03 (2.01-127.46)	0.009
Sepsis	No	1
	Yes	6.50 (3.01-14.06)	< 0.001
AKI	No	1
	Yes	2.69 (1.17-6.20)	0.02
INR		1.75 (1.14-2.69)	< 0.001

NSTEMI: non-ST-elevation myocardial infarction; AKI: acute kidney injury; INR: international normalized ratio; OR: odds ratio; CI: confidence interval.

Table 3 Multivariate analysis of factors predicting morbidity

		OR (95%CI)	P value
CKD	No	1
	Yes	3.18 (1.30-7.82)	0.01
MELD-Na		1.05 (1.01-1.08)	0.005
Albumin		0.55 (0.32-0.92)	0.02

Prolonged hospital stay > 5 d (120 h) or readmission within 7 d of the index admission; CKD: chronic kidney disease; MELD: Model for End-Stage Liver Disease; OR: odds ratio; CI: confidence interval.

Table 4 Multivariate analysis of factors predicting both mortality and morbidity

		OR (95%CI)	P value
CKD	No	1
	Yes	3.12 (1.21-8.06)	0.01
TLC		1.08 (1.03-1.12)	< 0.001
Child Class		3.57 (2.20-5.79)	< 0.001

CKD: chronic kidney disease; TLC: total leukocyte count; OR: odds ratio; CI: confidence interval.

Table 5 The relationship between predictor of mortality and non-communicable diseases, n (%)

	NCDs		P value
	Yes	No
	210 (52.6)	189 (47.3)
NSTEMI	7 (3.3)	0	0.01
Sepsis	31 (14.8)	39 (20.6)	0.14
AKI	92 (44.7)	76 (40.2)	0.41

NSTEMI: non-ST-elevation myocardial infarction; INR: international normalized ratio; AKI: acute kidney injury; NCDs: non-communicable diseases.