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Al Kaabi H, Al Alawi AM, Al Falahi Z, Al-Naamani Z, Al Busafi SA. Clinical Characteristics, Etiology, and Prognostic Scores in Patients with Acute Decompensated Liver Cirrhosis. J Clin Med 2023; 12:5756. [PMID: 37685822 PMCID: PMC10488876 DOI: 10.3390/jcm12175756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/26/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Chronic liver disease and cirrhosis contribute significantly to global mortality, with limited improvements despite medical advancements. This study aims to evaluate acute decompensation of liver cirrhosis characteristics, etiology, and survival outcomes in Oman. In addition, we examined the accuracy of prognostic scores in predicting mortality at 28 and 90 days. METHODS We conducted a retrospective analysis of 173 adult patients with acute decompensation of liver cirrhosis at Sultan Qaboos University Hospital in Oman. We collected demographic, clinical, and biochemical data, including etiology, prognostic scores (CTP, MELD-Na, CLIF-C), and health outcomes. RESULTS Alcohol (29.5%), hepatitis C (27.75%), and hepatitis B (26.74%) were the predominant causes of liver cirrhosis in our cohort. Hepatic encephalopathy, mechanical ventilation, and admission to the intensive care unit were strongly associated with an increased mortality rate. The 1-year readmission rate stood at 42.2%. Liver transplantation was performed in 4.1% of cases. The overall mortality rate was approximately 40% during the follow-up period, and the cumulative 28-days and 90-days mortality rates were 20.8% and 25.4%, respectively. Prognostic scores (CTP, MELD-Na, CLIF-C) effectively predicted 28- and 90-day mortality, with CLIF-C demonstrating superior performance (AUROC 0.8694 ± 0.0302 for 28-day mortality and AUROC 0.8382 ± 0.0359 for 90-day mortality). CONCLUSION Alcohol and viral hepatitis are the leading causes of liver cirrhosis in our study. Hepatic encephalopathy is a significant predictor of poor outcomes. Prognostic scores (CTP, MELD-Na, CLIF-C) have valuable predictive abilities for short-term mortality. These findings highlight the importance of public strategies to reduce alcohol consumption and the need for the comprehensive management of liver cirrhosis in Oman. Early diagnosis and intervention can improve clinical outcomes and support the establishment of a national organ transplantation program to address the healthcare challenge effectively.
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Affiliation(s)
- Hoor Al Kaabi
- Internal Medicine Residency Training Program, Oman Medical Specialty Board, Muscat 130, Oman; (H.A.K.); (Z.A.F.); (S.A.A.B.)
| | - Abdullah M. Al Alawi
- Internal Medicine Residency Training Program, Oman Medical Specialty Board, Muscat 130, Oman; (H.A.K.); (Z.A.F.); (S.A.A.B.)
- Department of Medicine, Sultan Qaboos University Hospital, Muscat 123, Oman;
| | - Zubaida Al Falahi
- Internal Medicine Residency Training Program, Oman Medical Specialty Board, Muscat 130, Oman; (H.A.K.); (Z.A.F.); (S.A.A.B.)
- Department of Medicine, Sultan Qaboos University Hospital, Muscat 123, Oman;
| | - Zakariya Al-Naamani
- Department of Medicine, Sultan Qaboos University Hospital, Muscat 123, Oman;
| | - Said A. Al Busafi
- Internal Medicine Residency Training Program, Oman Medical Specialty Board, Muscat 130, Oman; (H.A.K.); (Z.A.F.); (S.A.A.B.)
- Department of Medicine, Sultan Qaboos University Hospital, Muscat 123, Oman;
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman
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Al Busaidi S, Al Alawi AM, Al Masruri R, Al Balushi S, Al-Badi A. Quality of death certification based on the documented underlying cause of death: A retrospective study. J Forensic Leg Med 2023; 97:102547. [PMID: 37307775 DOI: 10.1016/j.jflm.2023.102547] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/09/2023] [Accepted: 05/29/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND The underlying cause of death (UCOD) documented in the death certificate is a cornerstone in the mortality data that has significant impact on national policies, health system, and socioeconomics. However, a wide range of inaccuracies have been reported worldwide and were linked to multiple factors, including sociodemographic development and lack of physician training. Hence, this study aimed to assess the quality of death certification by reviewing the reported UCOD in the death certificate and study the potential factors that might be associated with inaccuracies. METHODS All in-patient deaths that occurred in the Sultan Qaboos University Hospital from January 2020 to 31 December 2020 were included in this retrospective study. The study investigators reviewed all death certifications that were recorded during the study period for the accuracy of the documented UCOD using a systemic framework recommended by the World Health Organization. RESULTS The study included 384 mortality cases. The mean age at the time of death was 55.7 ± 27.1 years, and 209 (54.3%) cases were men. Approximately 80% (95% confidence interval: 84-76%) of the deceased patients had inaccurate data on the UCOD. Old age (58.1 ± 25.8 vs 46.5 ± 30.1, p < 0.001), death certification by doctor in training (70.8% vs 51.9%, p = 0.001), and admission under the Department of Medicine (68.5% vs 54.4%, p = 0.019) were more common in mortality cases with inaccurate data on the UCOD. Regression analysis confirmed that old age, male sex, and certification by doctor in training were independent predictors of inaccurate data on the UCOD. CONCLUSION Inaccurate data on the UCOD is a prevalent issue in many healthcare settings, especially in the developing countries. Introduction of death certification training in the medical curriculum for medical doctors, implementation of periodic auditing, and provision of feedback are among the evidence-based approaches that are likely to improve the overall accuracy of mortality data.
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Affiliation(s)
- Salim Al Busaidi
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman; Internal Medicine Training Program, Oman Medical Specialty Board, Muscat, Oman.
| | - Abdullah M Al Alawi
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman; Internal Medicine Training Program, Oman Medical Specialty Board, Muscat, Oman.
| | - Reema Al Masruri
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
| | - Shahad Al Balushi
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
| | - Amira Al-Badi
- Internal Medicine Training Program, Oman Medical Specialty Board, Muscat, Oman.
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Al-Maqbali JS, Al Alawi AM, Al-Mamari Q, Al-Huraizi A, Al-Maqrashi N. Symptoms-triggered approach versus fixed-scheduled approach of benzodiazepines for management of alcohol withdrawal syndrome: Non-randomized controlled trial. Alcohol 2023; 106:10-14. [PMID: 36240945 DOI: 10.1016/j.alcohol.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Alcohol withdrawal syndrome, if untreated, can lead to potentially life-threatening complications. Benzodiazepines are the drugs of choice for the treatment of alcohol withdrawal syndrome. We aimed to compare the symptoms-triggered approach and fixed-dose approach of benzodiazepine administration for treatment of alcohol withdrawal syndrome in regard to the health care utilization measured by the total dose of benzodiazepines, length of hospital stays, and 90-day readmissions rate. METHODS A single-center prospective non-randomized controlled trial included all patients diagnosed with alcohol withdrawal syndrome. The group of patients admitted between October 1, 2019, and September 30, 2020, were treated with the fixed-scheduled approach (n = 150), while all patients admitted between November 1, 2020, to October 31, 2021, were treated with the symptoms-trigger approach (n = 50). RESULTS The fixed-dose approach group showed a significant higher 90-day readmissions rate (HR: 2.61; 95% CI = 1.18, 6.84; p = 0.01). Kaplan-Meier survival analysis showed a significantly shorter duration to the first readmission in the fixed-scheduled approach group (HR: 2.3; 95% CI = 5.6, 1.16; p = 0.02). The symptoms-triggered approach group required a significantly lower dose of diazepam (40 mg vs. 10 mg; p < 0.01) and a higher dose of thiamine (800 mg vs. 600 mg; p < 0.01). Length of hospital stay was significantly increased in the symptoms-triggered approach group (3.9 vs. 2.2 days; p < 0.01). DISCUSSION The use of a symptoms-triggered approach to treat alcohol withdrawal syndrome was associated with a lower 90-day readmission rate, prolonged period to the first readmission, and reduced total dose of benzodiazepines, but longer length of hospital stays. CONCLUSION The symptoms-triggered approach is safe, cost-effective, and associated with reduced alcohol dependence relapse.
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Affiliation(s)
| | - Abdullah M Al Alawi
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman; Internal Medicine Training Program, Oman Medical Specialty Board, Muscat, Oman.
| | - Qasim Al-Mamari
- Department of Nursing, Sultan Qaboos University Hospital, Muscat, Oman
| | - Aisha Al-Huraizi
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Nasiba Al-Maqrashi
- Internal Medicine Training Program, Oman Medical Specialty Board, Muscat, Oman
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Suárez-Cuenca JA, Toledo-Lozano CG, Espinosa-Arroyo MD, Vázquez-Aguirre NA, Fonseca-González GT, Garro-Almendaro K, Melchor-López A, García-López VH, Ortiz-Matamoros A, Ortega-Rosas T, Alcaraz-Estrada SL, Mondragón-Terán P, García S. Diagnostic Performance of AST Scale in Mexican Male Population for Alcohol Withdrawal Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159208. [PMID: 35954565 PMCID: PMC9367724 DOI: 10.3390/ijerph19159208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022]
Abstract
Alcohol withdrawal syndrome (AWS) represents an adverse consequence of chronic alcohol use that may lead to serious complications. Therefore, AWS requires timely attention based on its early recognition, where easy-to-apply diagnostic tools are desirable. Our aim was to characterize the performance of a short-scale AST (Anxiety, Sweats, Tremors) in patients from public general hospitals. We conducted a cross-sectional study of patients attended at the Emergency Department diagnosed with AWS. Three scales were applied: CIWA-Ar (Clinical Institute Retirement Assessment Scale-Revised), GMAWS (Glasgow Modified Alcohol Withdrawal Syndrome) and AST. Cronbach’s alpha and Cohen’s kappa tests were used for reliability and concordance. Factorial analysis and diagnostic performance including ROC curve were carried out. Sixty-eight males with a mean age of 41.2 years old, with high school education and robust alcohol consumption, were included. Mean scores for CIWA-Ar, GMWAS and AST were 17.4 ± 11.2, 3.9 ± 2.3 and 3.8 ± 2.6, respectively, without significant differences. The AST scale showed an acceptable reliability and concordance (0.852 and 0.439; p < 0.0001) compared with CIWA-Ar and GMAWS. AST component analysis evidenced tremor (77.5% variance), sweat (12.1% variance) and anxiety (10.4% variance). Diagnostic performance of the AST scale was similar to the GMAWS scale, evidencing a sensitivity of 84%, specificity of 83.3% and Area Under the Curve (AUC) of 0.837 to discriminate severe AWS, according to CIWA-Ar. The performance of the AST scale to evaluate AWS is comparable with the commonly used CIWA-Ar and GMAWS scales. AST further represents an easy-to-apply instrument.
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Affiliation(s)
- Juan Antonio Suárez-Cuenca
- Internal Medicine Department, Hospital General Xoco, SEDESA, Mexico City 03330, Mexico; (J.A.S.-C.); (M.D.E.-A.); (N.A.V.-A.); (K.G.-A.); (A.M.-L.)
- Department of Clinical Research, Centro Médico Nacional “20 de Noviembre”, ISSSTE, Mexico City 03229, Mexico; (A.O.-M.); (T.O.-R.)
| | - Christian Gabriel Toledo-Lozano
- Department of Clinical Research, Centro Médico Nacional “20 de Noviembre”, ISSSTE, Mexico City 03229, Mexico; (A.O.-M.); (T.O.-R.)
- Correspondence: (C.G.T.-L.); (S.G.); Tel.: +52-551-956-2089 (C.G.T.-L.); +52-555-437-7491 (S.G.)
| | - Maryjose Daniela Espinosa-Arroyo
- Internal Medicine Department, Hospital General Xoco, SEDESA, Mexico City 03330, Mexico; (J.A.S.-C.); (M.D.E.-A.); (N.A.V.-A.); (K.G.-A.); (A.M.-L.)
| | - Nallely Alejandra Vázquez-Aguirre
- Internal Medicine Department, Hospital General Xoco, SEDESA, Mexico City 03330, Mexico; (J.A.S.-C.); (M.D.E.-A.); (N.A.V.-A.); (K.G.-A.); (A.M.-L.)
| | | | - Karen Garro-Almendaro
- Internal Medicine Department, Hospital General Xoco, SEDESA, Mexico City 03330, Mexico; (J.A.S.-C.); (M.D.E.-A.); (N.A.V.-A.); (K.G.-A.); (A.M.-L.)
| | - Alberto Melchor-López
- Internal Medicine Department, Hospital General Xoco, SEDESA, Mexico City 03330, Mexico; (J.A.S.-C.); (M.D.E.-A.); (N.A.V.-A.); (K.G.-A.); (A.M.-L.)
| | | | - Abril Ortiz-Matamoros
- Department of Clinical Research, Centro Médico Nacional “20 de Noviembre”, ISSSTE, Mexico City 03229, Mexico; (A.O.-M.); (T.O.-R.)
| | - Tania Ortega-Rosas
- Department of Clinical Research, Centro Médico Nacional “20 de Noviembre”, ISSSTE, Mexico City 03229, Mexico; (A.O.-M.); (T.O.-R.)
| | | | - Paul Mondragón-Terán
- Coordination of Research, Centro Médico Nacional “20 de Noviembre”, ISSSTE, Mexico City 03229, Mexico;
| | - Silvia García
- Department of Clinical Research, Centro Médico Nacional “20 de Noviembre”, ISSSTE, Mexico City 03229, Mexico; (A.O.-M.); (T.O.-R.)
- Correspondence: (C.G.T.-L.); (S.G.); Tel.: +52-551-956-2089 (C.G.T.-L.); +52-555-437-7491 (S.G.)
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