Qazi Arisar Fakhar Ali, Abid Shahab, Shaikh Preet Ayoub, Awan Safia
Section of Gastroenterology, Department of Medicine, Faculty Offices Building, the Aga Khan University Hospital, Karachi 74800, Pakistan.
World J Hepatol. 2018 Dec 27;10(12):944-955. doi: 10.4254/wjh.v10.i12.944.
To evaluate the impact of sepsis and non-communicable diseases (NCDs) on the outcome of decompensated chronic liver disease (CLD) patients.
In this cross-sectional study, medical records of patients with CLD admitted to the Gastroenterology unit at the Aga Khan University Hospital were reviewed. Patients older than 18 years with decompensation of CLD (., jaundice, ascites, encephalopathy, and/or upper gastrointestinal bleed) as the primary reason for admission were included, while those who were admitted for reasons other than decompensation of CLD were excluded. Each patient was followed for 6 wk after index admission to assess mortality, prolonged hospital stay (> 5 d), and early readmission (within 7 d).
A total of 399 patients were enrolled. The mean age was 54.3 ± 11.7 years and 64.6% ( = 258) were male. Six-week mortality was 13% ( = 52). Prolonged hospital stay and readmission were present in 18% ( = 72) and 7% ( = 28) of patients, respectively. NCDs were found in 47.4% ( = 189) of patients. Acute kidney injury, sepsis, and non-ST elevation myocardial infarction were found in 41% ( = 165), 17.5% ( = 70), and 1.75% ( = 7) of patients, respectively. Upon multivariate analysis, acute kidney injury, non-ST elevation myocardial infarction, sepsis, and coagulopathy were found to be statistically significant predictors of mortality. While chronic kidney disease (CKD), low albumin, and high Model for End-Stage Liver Disease (MELD)-Na score were found to be statistically significant predictors of morbidity. Addition of sepsis in conventional MELD score predicted mortality even better than MELD-Na (area under receiver operating characteristic: 0.735 0.686; < 0.001). Among NCDs, CKD was found to increase morbidity independently.
Addition of sepsis improved the predictability of MELD score as a prognostic marker for mortality in patients with CLD. Presence of CKD increases the morbidity of patients with CLD.
评估脓毒症和非传染性疾病（NCDs）对失代偿期慢性肝病（CLD）患者预后的影响。
在这项横断面研究中，回顾了阿迦汗大学医院胃肠病科收治的CLD患者的病历。纳入以CLD失代偿（如黄疸、腹水、肝性脑病和/或上消化道出血）为主要入院原因的18岁以上患者，排除因CLD失代偿以外原因入院的患者。每位患者在首次入院后随访6周，以评估死亡率、住院时间延长（>5天）和早期再入院（7天内）情况。
共纳入399例患者。平均年龄为54.3±11.7岁，男性占64.6%（n=258）。6周死亡率为13%（n=52）。分别有18%（n=72）和7%（n=28）的患者出现住院时间延长和再入院情况。47.4%（n=189）的患者患有NCDs。分别有41%（n=165）、17.5%（n=70）和1.75%（n=7）的患者出现急性肾损伤、脓毒症和非ST段抬高型心肌梗死。多因素分析显示，急性肾损伤、非ST段抬高型心肌梗死、脓毒症和凝血功能障碍是死亡率的统计学显著预测因素。而慢性肾脏病（CKD）、低白蛋白和终末期肝病模型（MELD）-钠评分升高是发病的统计学显著预测因素。在传统MELD评分中加入脓毒症预测死亡率甚至比MELD-钠评分更好（受试者工作特征曲线下面积：0.735对0.686；P<0.001）。在NCDs中，发现CKD独立增加发病率。
加入脓毒症可提高MELD评分作为CLD患者死亡率预后标志物的预测能力。CKD的存在增加了CLD患者的发病率。
