Risk factors associated with in hospital mortality related to cirrhosis liver.

Sridhar, K (2011) Risk factors associated with in hospital mortality related to cirrhosis liver. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION : Once patients with cirrhosis experience decompensation, mortality risk increases. The causes of mortality in decompensated cirrhosis patients are many fold. Both hepatic dysfunction and non hepatic causes have been implicated in causation of death in decompensated cirrhotic patients Not all patients admitted with decompensated cirrhosis deteriorate. Many improve with intensive treatment and are discharged. However some patients deteriorate in spite of intensive treatment and die. The short-term prognosis of acutely ill patients with cirrhosis is influenced by the degree of hepatic insufficiency and by dysfunction of extrahepatic organ systems Child-Pugh score has been the reference for many years for assessing the prognosis of cirrhosis. However, Child-Pugh score has important limitations, making it difficult to categorize patients according to their own disease severity. The model for end-stage liver disease (MELD) score, which was originally designed for assessing the prognosis of cirrhotic patients undergoing transjugular intrahepatic portosystemic shunt (TIPS), is a continuous score relying on three objective variables. However both CTP score and MELD are associated with many limitations. Mainly they are not used used in assessing prognosis during hospitalization. Many other biochemical and hematological variables can be associated with mortality and can be predictive. Assessment of prognosis during hospitalization mortality can have important role in triaging for level of care. AIM OF THE STUDY ; 1. To find out the causes of hospital mortality in patients admitted with decompensated cirrhosis of liver 2. To evaluate for the biochemical and hematological parameters that are related to mortality during hospitalization Materials and Methods : Cirrhotic patients admitted to the Section of Gastroenterology of Govt Stanley Medical College and hospital, a tertiary hospital, from January 2010 to may 2011 were studied. Patients with decompensated cirrhosis liver who died during admission were selected as cases. Patients admitted with cirrhosis and its complications and who improved with treatment followed by discharge were selected as controls. Cases and controls were selected in a blinded manner. Data collected included demographics; etiology of cirrhosis; indication for hospital admission; presence or absence of decompensation and portal hypertension; and the corresponding Child Pugh, MELD, and MELD-Na scores. Other hematological and biochemical markers were studied. Ethical committee approval was obtained for the study The diagnosis of cirrhosis was made by clinical evaluation and with help of investigations. The clinical diagnosis of cirrhosis was made by a history of portal hypertension excluding other etiology, impaired liver function tests, impaired clotting parameters, ultrasonographic or computer tomographic criteria. CONCLUSION : 1. In my study, Inhospital mortality in cirrhosis is predominantly due to hepatic dysfunction. 2. The most common cause of mortality in decompensated cirrhosis is due to hepatic encephalopathy, hepato renal syndrome and upper gastro intestinal bleeding. 3. In my study -Intercurrent infections are associated with mortality and is the most common cause of mortality not related to hepatic decompensation in cirrhotic patients 4. In my study--Longer duration of disease, high leukocyte count, high neutrophilia, higher INR, high creatinine, high SGPT is associated with mortality. Patients who had died also exhibited higher MELD and MELD sodium value levels 5. Therefore when patients are admitted with hepatic decompensation, clinical parameter like duration of disease, hematological parameters like leukocyte count and neutrophilia, biochemical parameters like creatinine, SGPT and INR can help predict short term or in hospital mortality along with MELD and MELD sodium. 6. In my study - Child score did not help in predicting short term mortality in hospitalized patients.

Item Type: Thesis (Masters)
Uncontrolled Keywords: cirrhosis liver ; hospital mortality ; Risk factors.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 13 Jul 2017 04:19
Last Modified: 13 Jul 2017 04:19
URI: http://repository-tnmgrmu.ac.in/id/eprint/1585

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