Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 27, 2018; 10(12): 944-955
Published online Dec 27, 2018. doi: 10.4254/wjh.v10.i12.944
Impact of sepsis and non-communicable diseases on prognostic models to predict the outcome of hospitalized chronic liver disease patients
Fakhar Ali Qazi Arisar, Shahab Abid, Preet Ayoub Shaikh, Safia Awan
Fakhar Ali Qazi Arisar, Shahab Abid, Preet Ayoub Shaikh, Safia Awan, Section of Gastroenterology, Department of Medicine, Faculty Offices Building, the Aga Khan University Hospital, Karachi 74800, Pakistan
Author contributions: Abid S contributed to the study idea and design; Qazi Arisar FA, Shaikh PA, Awan S, and Abid S contributed to acquisition, analysis, or interpretation of data; Qazi Arisar FA wrote the initial draft; Abid S and Shaikh PA made critical revision for important intellectual content; all authors approved the final version of the manuscript and are accountable for all aspects of the work.
Institutional review board statement: This study was reviewed and granted exemption by the Ethical Review Committee of the Aga Khan University Hospital, Karachi.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained through a retrospective review of charts.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Shahab Abid, FACG, FCPS, MD, PhD, Professor, Section of Gastroenterology, Department of Medicine, Faculty Offices Building, the Aga Khan University Hospital, Stadium Road PO Box 3500, Karachi 74800, Pakistan. shahab.abid@aku.edu
Telephone: +92-21-34864656 Fax: +92-21-34934294
Received: August 4, 2018
Peer-review started: August 6, 2018
First decision: August 24, 2018
Revised: September 7, 2018
Accepted: October 17, 2018
Article in press: October 18, 2018
Published online: December 27, 2018
ARTICLE HIGHLIGHTS
Research background

Patients with decompensated chronic liver disease (CLD) are at high risk of complications. Various scores have been used to classify the severity of liver disease and to predict mortality. Recently, diabetes was found to impact mortality in cirrhotic patients. However, the impact of other comorbidities on mortality and morbidity has not been studied. Moreover, the impact of sepsis on available predictability scores has not been determined.

Research motivation

Given the limitations with the use of Child-Pugh and Model for End-Stage Liver Disease (MELD) scores, we wanted to come up with a new score to predict mortality and morbidity.

Research objective

The objective for this study included determination of sepsis, non-communicable diseases (NCDs), and acute kidney injury (AKI) in patients admitted with decompensated liver disease, along with their impact of NCDs on mortality and morbidity parameters. We also wanted to evaluate whether the addition of any other variable makes MELD a better tool as a prognostic marker.

Research methods

We performed a retrospective analysis of medical records of patients with CLD admitted at the Aga Khan University Hospital. All adult patients with decompensation of CLD (i.e., jaundice, ascites, encephalopathy, and/or upper gastrointestinal (GI) bleed) as the primary reason for admission were included. Multivariate analysis was performed to assess predictors of 6 wk mortality, prolonged hospital stay (> 5 d), and early readmission (within 7 d).

Research results

Six-week mortality rate was 13%. Prolonged hospital stay and readmission rates were 18% and 7%, respectively. NCDs were present in 47.4% of patients. AKI, sepsis, and NSTEMI were present in 41%, 17.5%, and 1.75% patients, respectively. Factors associated with mortality included AKI, NSTEMI, sepsis, and coagulopathy. The factors found responsible for morbidity included chronic kidney disease (CKD), low albumin, and high MELD-Na score. By adding sepsis to the conventional MELD score, the predictability of mortality increased significantly. CKD was found to impact morbidity independently.

Research conclusion

This study highlighted multiple factors associated with early mortality, readmission, and prolonged hospital stay. This study also determined the significance of the addition of sepsis in the MELD score to improve its predictability as a prognostic marker for mortality in patients with decompensated CLD. Presence of CKD increased morbidity of patients with CLD.

Research perspective

We need to amend factors linked to mortality, readmission, and prolonged stay not only to control mortality and morbidity, but also to minimize the cost burden by patients.