Razafindrazoto Chantelli Iamblaudiot, Randriamifidy Nitah Harivony, Ralaizanaka Behoavy Mahafaly, Andrianoelison Jean Tsitamita, Ravelomanantsoa Haga Tsilavo, Rakotomaharo Mialitiana, Hasina Laingonirina Domoina Harivonjy, Maherison Sonny, Rakotomalala Jolivet Auguste, Rasolonjatovo Anjaramalala Sitraka, Rakotozafindrabe Andry Lalaina Rinà, Rabenjanahary Tovo Harimanana, Razafimahefa Soloniaina Hélio, Ramanampamonjy Rado Manitrala
Gastroenterology Unit, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar.
Hepato-Gastroenterology Unit, University Hospital Andrainjato, Fianarantsoa, Madagascar.
Hepat Med. 2023 Mar 12;15:21-26. doi: 10.2147/HMER.S401628. eCollection 2023.
Cirrhosis is a pathology responsible for a significant hospital morbidity and mortality. The objective of this study was to determine the factors associated with hospital mortality in a sample of Malagasy cirrhotics.
This was a retrospective cohort study from January 2018 to August 2020 conducted in the Hepato-Gastroenterology Unity, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar.
One hundred and eight patients were included. The mean age was 51.13±13.50 years with a sex ratio of 2.37. The etiology of cirrhosis was dominated by alcohol (44.44%), hepatitis B virus (24.07%) and hepatitis C virus (13.89%). Twenty-eight patients (25.93%) had died. Factors associated with in-hospital mortality were hepatic encephalopathy (OR: 14.16; 95% CI: 5.08-39.4; p: 0.000), renal failure (OR: 8.55; 95% CI: 2.03-39.9; p: 0.0034), gastrointestinal bleeding (OR: 3.25; 95% CI: 1.32-7.92; p: 0.0099), hyponatraemia <130mmol/L (OR: 3.34; 95% CI: 1.04-10.6; p=0.046), Child-Pugh C classification (OR: 0.19; 95% CI: 0.12-0.21; p: 0.000), and MELD-Na score >32 (OR: 27.5; 95% CI: 4.32-174.8; p: 0.004).
The in-hospital mortality rate during acute decompensation of cirrhosis remains high in Madagascar. Hepatic encephalopathy, renal failure, GI bleeding and hyponatraemia are the main clinico-biological factors affecting in-hospital mortality. Early intervention on these modifiable factors is an important step to improve hospital outcomes. The natraemia, MELD score and MELD-Na score should be used in routine practice in Madagascar to identify patients with acute decompensation of cirrhosis at high risk of death.
肝硬化是导致医院内高发病率和死亡率的一种病理状态。本研究的目的是确定马达加斯加肝硬化患者样本中与医院死亡率相关的因素。
这是一项于2018年1月至2020年8月在马达加斯加塔那那利佛约瑟夫·拉塞塔·贝费拉塔纳纳大学医院肝病胃肠病科进行的回顾性队列研究。
共纳入108例患者。平均年龄为51.13±13.50岁，性别比为2.37。肝硬化的病因以酒精性（44.44%）、乙型肝炎病毒（24.07%）和丙型肝炎病毒（13.89%）为主。28例患者（25.93%）死亡。与住院死亡率相关的因素有肝性脑病（比值比：14.16；95%置信区间：5.08 - 39.4；p：0.000）、肾衰竭（比值比：8.55；95%置信区间：2.03 - 39.9；p：'0.0034）、胃肠道出血（比值比：3.25；95%置信区间：1.32 - 7.92；p：0.0099）、血钠<130mmol/L（比值比：3.34；95%置信区间：1.04 - 10.6；p = 0.046）、Child-Pugh C级分类（比值比：0.19；95%置信区间：0.12 - 0.21；p：0.000）以及终末期肝病模型钠评分>32（比值比：27.5；95%置信区间：4.32 - 174.8；p：0.004）。
在马达加斯加，肝硬化急性失代偿期的住院死亡率仍然很高。肝性脑病、肾衰竭、胃肠道出血和低钠血症是影响住院死亡率的主要临床生物学因素。对这些可改变因素进行早期干预是改善医院治疗效果的重要一步。在马达加斯加的常规实践中，应使用血钠、终末期肝病模型评分和终末期肝病模型钠评分来识别肝硬化急性失代偿且死亡风险高的患者。
