Short-term clinical outcomes of patients admitted with chronic liver disease to selected teaching hospitals in Ethiopia

Treatment outcomes of chronic liver disease and associated factors among patients treated at hospitals in Bahir Dar city, north-west Ethiopia

BACKGROUND

Chronic liver disease is an on-going loss of liver structure and functions that lasts for at least six months. About 1.5 billion population suffered with this devastating disease worldwide.

OBJECTIVES

The aim of this study is to assess the treatment outcome and associated factors in patients with chronic liver disease at Bahir Dar, North West Ethiopia.

METHOD

A retrospective cross sectional study was conducted in both governmental and private hospitals of Bahir Dar city from January to August 2024. All patients with liver disease for at least six months and treated for their specific causes and/or complications were included. Descriptive statistics was employed to explain socio-demographic and relevant clinical characteristics. Binary logistic regression was employed to determine associated factors with poor treatment outcome. Texts, tables and charts used to present statistically and/or clinically significant results. A p-value of < 0.05 was considered statistically significant.

RESULT

A total of 213 medical records of chronic liver disease patients were reviewed. Most of the study participants (72.8%) were male and resided in rural area (63.8%). Viral hepatitis was the most frequent (60.0%) etiology followed by parasitic (23.0%) and alcohol misuse (11.5%). The percentage of patients with chronic liver disease who experienced poor treatment outcomes was 39.0% and 54.2% were not taking medications specifically tailored to their condition. Stages of chronic liver disease (AOR = 2.68; 95%CI: 1.50-4.76, p = 0.001), carcinoma status (AOR = 2.68; 95%CI: 1.07-6.68, p = 0.035) and treatment duration (AOR = 0.38; 95%CI: 0.15-0.98, p = 0.045) were independent predictors for poor treatment outcome.

CONCLUSION

The overall treatment outcome of chronic liver disease in our study was inadequate. Decompensated stages of cirrhosis, cellular carcinoma and shorter treatment duration were significant factors of treatment failure. Timely initiation of appropriate therapy is warranted to improve the treatment outcome of chronic liver disease patients.

Portal vein congestion index in patients with and without chronic liver disease

Aim of the study

Portal vein congestion index has shown promise in detecting early portal venous hemodynamic changes in chronic liver disease. The aim of this study was to compare the portal vein congestion index of adult patients with chronic liver disease to that of healthy controls, and to evaluate the differences in portal vein congestion index, if any, between the common etiologies of chronic liver disease (chronic viral hepatitis, alcoholic liver disease, and non-alcoholic fatty liver disease).

Method and materials

Eighty participants with chronic liver disease and 80 healthy controls had their sociodemographic variables, anthropometric indices, liver size/echotexture, spleen size, presence of ascites, and portal vein parameters (diameter, cross-sectional area, velocity, and congestion index) evaluated. P ≤0.05 was considered statistically significant.

Results

There were 48 (60%) males and 32 (40%) females in the control group, while 56 (70%) males and 24 (30%) females were included in the chronic liver disease group (p = 0.185). Of the eighty people with chronic liver disease, 57 (71.2%) were diagnosed with alcoholic liver disease, while 23 (28.8%) were diagnosed with chronic viral hepatitis. There were no cases of non-alcoholic fatty liver disease during the study period. The mean liver spans of the control and chronic liver disease groups were 13.45 ± 0.85 cm and 16.50 ± 4.96 cm, respectively. All the controls had normal hepatic parenchymal echogenicity, while 45 (56.3%) subjects with chronic liver disease (36 alcoholic liver disease and 9 chronic viral hepatitis) had increased hepatic echogenicity. The mean values of the portal vein congestion index for the control and chronic liver disease groups were 0.0775 ± 0.02 cm/sec and 0.1037 ± 0.03 cm/sec, respectively (p <0.0001).

Conclusion

The chronic liver disease group showed a significantly higher mean portal vein congestion index than the control group.

Chronic Liver Disease in Ethiopia with a Particular Focus on the Etiological Spectrums: A Systematic Review and Meta-Analysis of Observational Studies

Background

In Ethiopia, chronic liver disease (CLD) is the 7th leading cause of death, accounting for about 24 deaths per 100000 populations in 2019. Despite its burden, there is a lack of compiled pieces of evidence on CLD in the country. Thus, this systematic review and meta-analysis is intended to provide the pooled estimates of CLD etiologies and mortality rate in CLD patients in Ethiopia.

Method

PubMed, Google Scholar, ScienceDirect, institutional repositories, national digital library, and the bibliography of the eligible articles information were the source of data for the present review. The keywords "hepatitis, chronic" [Mesh], "end-Stage Liver Disease" [Mesh], "chronic liver disease", "liver cirrhosis" [Mesh], and "Ethiopia" were used for the searches. Overall, we retrieved 199 records and 12 were included in this review. We used the DerSimonian-Laird random-effects models to perform the meta-analysis. We conducted subgroup and meta-regression analyses to account for the heterogeneity of the estimates.

Result

Hepatitis B virus, alcohol, and hepatitis C virus are the three most common etiologies of CLD in Ethiopia accounting for a pooled estimate of 40.0% [95% CI: 29.0, 51.0, I 2 = 96.3, p < 0.001], 17.0% [95% CI: 9.0, 25.0, I 2 = 96.7, p < 0.001], and 15.0% [95% CI: 9.0, 21.0, I 2 = 95.8, p < 0.001], respectively. Unidentified etiology report has a substantial contribution accounting for an estimated pooled proportion of 45% [95% CI: 34.0, 56.0%, Q = 32.08, p < 0.001, I 2 = 87.53] of the CLD cases in the country. On the other hand, the overall hospital mortality rate in CLD patients is 25.0% [95% CI: 2.0, 47.0, I2 = 94.6, p < 0.001] in Ethiopia.

Conclusion

Hepatitis B virus, hepatitis C virus, and alcohol are the three most common contributors to CLD cases in Ethiopia. The authors warrant routine screening and strengthening of preventive and treatment programs for viral hepatitis B and C, further enhancing the alcohol policy of the country.

Sociodemographic characteristics, complications requiring hospital admission and causes of in-hospital death in patients with liver cirrhosis admitted at a district hospital in Ghana

BACKGROUND

Chronic liver diseases including liver cirrhosis are a major cause of morbidity and mortality globally. Despite the high burden of liver cirrhosis in Ghana, data on this disease is lacking.

OBJECTIVE

To determine the sociodemographic characteristics, reasons for admission, and in-hospital mortality of patients with cirrhosis of the liver seen at a district hospital in Ghana.

METHODS

A prospective study was conducted involving one hundred and eighty-six (186) patients admitted on the medical wards in St. Dominic hospital with liver cirrhosis from 1st January 2018 to 24th June 2020. The patient's demographic and clinical features were documented using a standardized questionnaire. Diagnostic biochemical and haematological tests as well as abdominal ultrasound scans were performed for all patients. They were followed up until death or discharge from hospital.

RESULTS

One hundred and eighty-six patients (186) with a median age of 46 years were included in the study. HBV was the main etiology of liver cirrhosis (38.7%) followed closely by alcohol consumption (38.3%). In-hospital mortality was 41.3% and the most frequent cause of death was hepatic encephalopathy (68.4%). The following were associated with death; Jaundice, weight loss, elevated bilirubin, international normalized ratio (INR), creatinine, blood urea nitrogen(BUN), Child-Pugh score, model for end-stage liver disease sodium score (MELDNa), and low sodium. However, hepatic encephalopathy, MELDNa, INR and BUN were independent predictors of in-hospital mortality on logistic regression analysis.

CONCLUSIONS

In-hospital mortality in cirrhotic patients was high with the leading cause of death being hepatic encephalopathy. Timely diagnosis and adequate management of hepatic encephalopathy are necessary to prevent death from liver cirrhosis.