<b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:Verdana;">Cirrhosis, an ineluctable development of chronic liver disease, still h...<b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:Verdana;">Cirrhosis, an ineluctable development of chronic liver disease, still has high mortality throughout the world despite many advances in physiopathology and therapy. This high mortality is closely </span><span style="font-family:Verdana;">related</span><span style="font-family:Verdana;"> to the unpredictable course of cirrhosis with numerous complications.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:""><span style="font-family:Verdana;"> To evaluate the predictive factors of death during cirrhosis. </span><b><span style="font-family:Verdana;">Materials and methods:</span></b><span style="font-family:Verdana;"> This is an observational, descriptive study on cirrhotic patients hospitalized in the hepatology unit of the Center Hospitalier Universitaire in Bouake (Ivory Coast) during the period from January 01, 2018 to December 31, 2019. The study focused on the data collected in the medical files (paper format) of hospitalized cirrhotics and the death register of the service.</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">The diagnosis of cirrhosis and the death of the cirrhotic were the main criteria for judgment. The secondary criteria defined were: history of cirrhosis, reasons for consultation, clinical signs, biological signs, complications of cirrhosis</span><span style="font-family:Verdana;"> and</span><span style="font-family:Verdana;"> the treatment received. The relationship between the parameters was expressed as an odds ratio (OR) with a 95% confidence interval (CI) and the significance threshold fixed at p <</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">0.05. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">The study retained 206 files of cirrhotics including 146 men and 60 women.</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">The hospital prevalence of cirrhosis was 44.17% and the mortality rate was 42.23%.</span><span style="font-family:""> </span><span style="font-family:Verdana;">The deceased patients were mainly men with an average age of 49 years.</span><span style="font-family:""> </span><span style="font-family:Verdana;">The etiologies of cirrhosis were dominated by viral hepatitis B, chronic alcohol poisoning and viral hepatitis C, respectively 46.95%, 37.35% and 10.84%. The predictors of death were: the presence of icterus (OR</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 1.89, 95%CI [1.08</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">3.30], p = 0.036), hepatic encephalopathy (OR</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 8.75,</span><span style="font-family:""> </span><span style="font-family:Verdana;">95%CI [4.51</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">16.94], p < 0.001) and hepatocellular carcinoma (OR</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 2.23,</span><span style="font-family:""> </span><span style="font-family:Verdana;">95%CI [1.25</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">3.98], p</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 0.010);the presence in the biology of hepatic cytolysis (OR</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 2.57, 95%CI [1.35</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">4.89], p</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 0.006), severe hepatocellular insufficiency (OR</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 2.57,</span><span style="font-family:""> </span><span style="font-family:Verdana;">95%CI [1.38</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">4.77], p</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 0.004), severe renal insufficiency</span><span style="font-family:""> </span><span style="font-family:Verdana;">(OR</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 2.41,</span><span style="font-family:""> </span><span style="font-family:Verdana;">95%CI [1.09</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">5.32], p</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 0.044)</span><span style="font-family:""> </span><span style="font-family:Verdana;">and hyperleukocytosis (OR</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 2.28,</span><span style="font-family:""> </span><span style="font-family:Verdana;">95%CI [1.29</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">4.04], p</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 0.007);Child-Pugh stage C (OR</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 19.64,</span><span style="font-family:""> </span><span style="font-family:Verdana;">95%CI [9.02</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">42.74], p</span><span style="font-family:""> </span><span style="font-family:Verdana;"><</span><span style="font-family:""> </span><span style="font-family:Verdana;">0.001);the presence on ultrasound of large liver</span><span style="font-family:""> </span><span style="font-family:Verdana;">and variable nodules (OR</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 4.16, 95%CI [2.02</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">8.58], p < 0.001). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Cirrhosis is a public health problem at the Bouake university hospiler center. Decompensated and complicated old cirrhosis, hepatic cytolysis, severe hepatocellular insufficiency, severe renal insufficiency and hyperleukocytosis, heterogeneous nodular large liver are the detrimental factors.展开更多
文摘<b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:Verdana;">Cirrhosis, an ineluctable development of chronic liver disease, still has high mortality throughout the world despite many advances in physiopathology and therapy. This high mortality is closely </span><span style="font-family:Verdana;">related</span><span style="font-family:Verdana;"> to the unpredictable course of cirrhosis with numerous complications.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:""><span style="font-family:Verdana;"> To evaluate the predictive factors of death during cirrhosis. </span><b><span style="font-family:Verdana;">Materials and methods:</span></b><span style="font-family:Verdana;"> This is an observational, descriptive study on cirrhotic patients hospitalized in the hepatology unit of the Center Hospitalier Universitaire in Bouake (Ivory Coast) during the period from January 01, 2018 to December 31, 2019. The study focused on the data collected in the medical files (paper format) of hospitalized cirrhotics and the death register of the service.</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">The diagnosis of cirrhosis and the death of the cirrhotic were the main criteria for judgment. The secondary criteria defined were: history of cirrhosis, reasons for consultation, clinical signs, biological signs, complications of cirrhosis</span><span style="font-family:Verdana;"> and</span><span style="font-family:Verdana;"> the treatment received. The relationship between the parameters was expressed as an odds ratio (OR) with a 95% confidence interval (CI) and the significance threshold fixed at p <</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">0.05. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">The study retained 206 files of cirrhotics including 146 men and 60 women.</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">The hospital prevalence of cirrhosis was 44.17% and the mortality rate was 42.23%.</span><span style="font-family:""> </span><span style="font-family:Verdana;">The deceased patients were mainly men with an average age of 49 years.</span><span style="font-family:""> </span><span style="font-family:Verdana;">The etiologies of cirrhosis were dominated by viral hepatitis B, chronic alcohol poisoning and viral hepatitis C, respectively 46.95%, 37.35% and 10.84%. The predictors of death were: the presence of icterus (OR</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 1.89, 95%CI [1.08</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">3.30], p = 0.036), hepatic encephalopathy (OR</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 8.75,</span><span style="font-family:""> </span><span style="font-family:Verdana;">95%CI [4.51</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">16.94], p < 0.001) and hepatocellular carcinoma (OR</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 2.23,</span><span style="font-family:""> </span><span style="font-family:Verdana;">95%CI [1.25</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">3.98], p</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 0.010);the presence in the biology of hepatic cytolysis (OR</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 2.57, 95%CI [1.35</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">4.89], p</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 0.006), severe hepatocellular insufficiency (OR</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 2.57,</span><span style="font-family:""> </span><span style="font-family:Verdana;">95%CI [1.38</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">4.77], p</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 0.004), severe renal insufficiency</span><span style="font-family:""> </span><span style="font-family:Verdana;">(OR</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 2.41,</span><span style="font-family:""> </span><span style="font-family:Verdana;">95%CI [1.09</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">5.32], p</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 0.044)</span><span style="font-family:""> </span><span style="font-family:Verdana;">and hyperleukocytosis (OR</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 2.28,</span><span style="font-family:""> </span><span style="font-family:Verdana;">95%CI [1.29</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">4.04], p</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 0.007);Child-Pugh stage C (OR</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 19.64,</span><span style="font-family:""> </span><span style="font-family:Verdana;">95%CI [9.02</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">42.74], p</span><span style="font-family:""> </span><span style="font-family:Verdana;"><</span><span style="font-family:""> </span><span style="font-family:Verdana;">0.001);the presence on ultrasound of large liver</span><span style="font-family:""> </span><span style="font-family:Verdana;">and variable nodules (OR</span><span style="font-family:""> </span><span style="font-family:Verdana;">= 4.16, 95%CI [2.02</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">8.58], p < 0.001). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Cirrhosis is a public health problem at the Bouake university hospiler center. Decompensated and complicated old cirrhosis, hepatic cytolysis, severe hepatocellular insufficiency, severe renal insufficiency and hyperleukocytosis, heterogeneous nodular large liver are the detrimental factors.