Predictors of Intra-Hospital Mortality in Patients with Cirrhosis


Intra-hospital mortality in cirrhotic patients is variable depending on the studies reported in literature. Several studies have demonstrated independent predictors of mortality. The aim of this work is indeed to identify these predictors. Patients and Methods: We conducted a retrospective study of 1080 cirrhotic patients hospitalized in our department of gastroenterology and hepatology between January 2001 and August 2010. A descriptive study of the study population was performed, and a univariate analysis looking for an association between intra-hospital mortality, and clinical, biological, etiological and sociodemographic characteristics of our patients. Results: The average age of our patients was 54 years, with an equal number of men and women. 41.1% of patients had cirrhosis secondary to hepatitis C and 18.5% had cirrhosis secondary to hepatitis B. 26.1% of our patients were CHILD C. Intra-hospital mortality was 8.7% (97 deaths) with a mean of 23.4 ± 35.8 months. Univariate analysis showed that the intra-hospital mortality was significantly associated with higher age (p = 0.049) as well as the reasons for admissions like hepatic encephalopathy, and hematemesis (p < 0.0001), melena, jaundice and ascites (p = 0.001). Among the biological parameters analyzed in univariate analysis, significant associations with mortality were objectified for high white blood cell count (p = 0.035), and high serum bilirubin and creatinine (p < 0.0001); low rate of prothrombin time (PT) (p < 0.0001), of albumin (p = 0.0001) and of serum sodium (p < 0.0001). Among the complications analyzed, significant associations with mortality were objectified for jaundice, ascites (p = 0.001), hemorrhagic decompensation, hepatic encephalopathy, and spontaneous bacterial peritonitis (p < 0.001). Univariate analysis of the etiology of cirrhosis objectified significant associations for cirrhosis secondary to hepatitis B (p = 0.001) and hepatitis C (p = 0.022). Multivariate analysis objectified four independent predictors of mortality: hepatic encephalopathy, infection (hyper leukocytosis ≥ 10,000/mm3), renal failure (serum creatinine ≥ 15 mg/l) and hyponatremia. Conclusion: In our series, we identified four independent predictors of intra-hospital mortality in cirrhotic patients: hepatic encephalopathy, infection, renal failure and hyponatremia.

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Charif, I. , Saada, K. , Mellouki, I. , El Yousfi, M. , Benajah, D. , El Abkari, M. , Ibrahimi, A. and Aqodad, N. (2014) Predictors of Intra-Hospital Mortality in Patients with Cirrhosis. Open Journal of Gastroenterology, 4, 141-148. doi: 10.4236/ojgas.2014.43021.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Child, C.G. and Turcotte, J.G. (1964) Surgery and Portal Hypertension. In: Child, C.G., Ed., The Liver and Portal Hypertension, Saunders, Philadelphia, 50-64.
[2] Gines, P., Quintero, E., Arroyo, V., Teres, J., Bruguera, M., Rimola, A., Caballeri, J., Rodes, J. and Rozman, C. (1987) Compensated Cirrhosis: Natural History and Prognostic Factors. Hepatology, 7, 122-128.
[3] Adler, M., Verset, D., Bouhdid, H., Bourgeois, B., Gulbis, B., Le Moine, O., Vanderstadt, J., Gelin, M. and Thiry, P. (1997) Prognostic Evaluation of Patients with Parenchymal Cirrhosis: Proposal of a New Simple Score. Journal of Hepatology, 26, 642-649.
[4] Merkel, C., Bolognesi, M., Bellow, S., Bianco, S., Honisen, B., Lampe, H., Angeli, P. and Gatta, A. (1992) Aminopyrine Breath Test in the Prognostic Evaluation of Patients with Cirrhosis. Gut, 33, 836-642.
[5] Kamath, P.S., Wiesner, R.H., Malinchoc, M., Kremers, W., Therneau, T.M., Kosberg, C.L., D’Amico, G., Dickson, E.R. and Kim, W.R. (2001) A Model to Predict Survival in Patients with End-Stage Liver Disease. Hepatology, 33, 464-470.
[6] Orrego, H., Israel, Y., Blake, J.E. and Medline, A. (1983) Assessment of Prognostic Factors in Alcoholic Liver Disease: Toward a Global Quantitative Expression of Severity. Hepatology, 3, 896-905.
[7] Pingon, J.P., Poynard, T., Naveau, S., Marteau, P., Zourabien-Vilio, O. and Chaput, J.C. (1986) Analyse multidimensionnelle selon le modele de Cox dela survie de patients atteints de cirrhose alcoolique. Gastroentérologie Clinique et Biologique, 10, 461-467.
[8] Pugh, R.N.H., Murray-Lyon, I.M., Dawson, J.L., Pietroni, M.C. and Williams, R. (1973) Transection of the Esophagus in Bleeding Oesophageal Varices. British Journal of Surgery, 60, 648-652.
[9] Teres, J., Baroni, R., Bordas, J.W., Visa, J., Pera, C. and Rodes, J. (1987) Randomized Trial of Portocaval Shunt Stapling Transection and Endoscopic Sclerotherapy in Uncontrolled Variceal Bleeding. Journal of Hepatology, 4, 159-167.
[10] Rikkers, L.F., Burnett, D.A., Volentine, G.D., Buchi, K.N. and Cormier, R.A. (1987) Shunt Surgery versus Endoscopic Sclerotherapy for Longterm Treatment of Variceal Bleeding. Early Results of a Randomized Trial. Annals of Surgery, 206, 201-271.
[11] Sauerbruch, T., Ansari, H., Wotzka, R., Soehendra, N. and Kopcke, W. (1988) Prognostic Factors in Cirrhosis of the Liver, Variceal Bleeding and Sclerotherapy: Comparison of Prognosis Systems Obtained by Discriminant Analysis with the Child-Classification. Deutsche Medizinische Wochenschrift, 113, 11-14.
[12] LeMoine, O., Adler, M., Bourgeois, N., Delhayne, M., Deviere, J., Gelin, M., Vandermeeren, A., Van Gossum, A. and Vereerstraeten, P. (1992) Factors Related to Early Mortality in Cirrhotic Patients Bleeding from Varices and Treated by Urgent Sclerotherapy. Gut, 33, 1381-1385.
[13] Infante-Rivard, C., Esnaola, S. and Villeneuve, J.P. (1987) Clinical and Statistical Validity of Conventional Prognostic Factors in Predicting Short-Term Survival among Cirrhotics. Hepatolology, 7, 660-664.
[14] Ferro, D., Saliola, M., Quintarelli, C., Alessandri, C., Basili, S. and Violi, F. (1992) 1-Year Survey of Patients with Advanced Liver Cirrhosis: Prognostic Value of Clinical and Laboratory Indexes Identified by the Cox Regression Model. Scandinavian Journal of Gastroenterology, 27, 852-856.
[15] Hartmann, A.H., Bircher, J. and Creutzfeldt, W. (1989) Superiority of the Child-Pugh Classification to Quantitative Liver Function Tests for Assessing Prognosis of Liver Cirrhosis. Scandinavian Journal of Gastroenterology, 24, 269-276.
[16] Zauner, C., Schneeweiss, B., Schneider, B., Madl, C., Klos, H., Kranz, A., Ratheiser, K., Kramer, L. and Lenz, K. (2000) Short-Term Prognosis in Critically Ill Patients with Liver Cirrhosis: An Evaluation of a New Scoring System. European Journal of Gastroenterology & Hepatology, 12, 517-522.
[17] Robert, R. and Veinstein, A. (2003) Pronostic du Malade Atteint de Cirrhose en Reanimation. Gastroentérologie Clinique et Biologique, 27, 877-881.
[18] De Franchis, R. (2005) Evolving Consensus in Portal Hypertension. Report of the Baveno IV Consensus Workshop on Methodology of Diagnosis and Therapy in Portal Hypertension. Journal of Hepatology, 43, 167-176.
[19] D’Amico, G. and De Franchis, R. (2003) Upper Digestive Bleeding in Cirrhosis. Post-Therapeutic Outcome and Prognostic Indicators. Hepatology, 38, 599-612.
[20] Moitinho, E., Escorsell, A., Bandi, J.C., et al. (1999) Prognostic Value of Early Measurements of Portal Pressure in Acute Variceal Bleeding. Gastroenterology, 117, 626-631.
[21] Luca, A., Angermayr, B., et al. (2007) An Integrated MELD Model including Serum Sodium and Age Improves the Prediction of Early Mortality in Patients with Cirrhosis. Liver Transplantation, 13, 1174-1180.
[22] Londoño, M.C., Cárdenas, A., Guevara, M., et al. (2007) MELD Score and Serum Sodium in the Prediction of Survival of Patients with Cirrhosis Awaiting Liver Transplantation. Gut, 56, 1283-1290.
[23] Botta, F., Giannini, E., Romagnoli, P., Fasoli, A., et al. (2003) MELD Scoring System Is Useful for Predicting Prognosis in Patients with Liver Cirrhosis and Is Correlated with Residual Liver Function: A European Study. Gut, 52, 134-139.
[24] Mouelhi, L., Ben Hammouda, I., Salem, M., Moussa, A., et al. (2010) Mortalité hospitalière des patients cirrhotiques admis en milieu de soins intensifs: facteurs pronostiques et apport des scores de gravité. Journal Africain d’Hépato-Gastroentérologie, 4, 17-21.
[25] Calès, P. and Pascal, J.P. (1988) Histoire naturelle des varices oesophagiennes au cours de la cirrhose (de la naissance à la rupture). Gastroentérologie Clinique et Biologique, 12, 245-254.
[26] Carbonell, N., Pauwels, A., Serfaty, L., Fourdan, O., Lévy, V.G. and Poupon, R. (2004) Improved Survival after Variceal Bleeding in Patients with Cirrhosis over the Past Two Decades. Hepatology, 40, 652-659.
[27] De Dombal, F.T., Clarke, J.R., Clamp, S.E., Malizia, G., Kotwal, M.R. and Morgan, A.G. (1986) Prognostic Factors in Upper G.I. Bleeding. Endoscopy, 18, 6-10.
[28] McCormick, P.A. and O’Keefe, C. (2001) Improving Prognosis Following a First Variceal Haemorrhage over Four Decades. Gut, 49, 682-685.
[29] Levacher, S., Letoumelin, P., Pateron, D., Blaise, M., Lapandry, C. and Pourriat, J.L. (1995) Early Administration of Terlipressin plus Glyceryl Trinitrate to Control Active Upper Gastrointestinal Bleeding in Cirrhotic Patients. Lancet, 346, 865-868.
[30] Singh, N., Gayowski, T., Wagener, M.M. and Marino, I.R. (1998) Outcome of Patients with Cirrhosis Requiring Intensive Care Unit Support: Prospective Assessment of Predictors of Mortality. Journal of Gastroenterology, 33, 73-79.
[31] Chalasani, N., Kahi, C., Francois, F., Pinto, A., Marathe, A., Bini, E.J., et al. (2003) Improved Patient Survival after Acute Variceal Bleeding: A Multicenter, Cohort Study. American Journal of Gastroenterology, 98, 653-659.
[32] Attia, K.A., Ackoundou-N’guessan, K.C., N’driyoman, A.T., et al. (2008) Child-Pugh-Turcott versus Meld Score for Predicting Survival in a Retrospective Cohort of Black African Cirrhotic Patients. World Journal of Gastroenterology, 14, 286-291.
[33] Bernard, B., Grangé, J.D., Nguyen Khac, E., Amiot, X., Opolon, P. and Poynard, T. (1999) Antibiotic Prophylaxis for the Prevention of Bacterial Infections in Cirrhotic Patients with Gastrointestinal Bleeding: A Metaanalysis. Hepatology, 29, 1655-1661.
[34] (2004) Conférence de consensus: Complications de l’hypertension portale. Gastroenterology, 28, B324-B334.
[35] Karoui, S., Hamzaoui, S., Sahli, F., et al. (2002) Mortalité au cours des cirrhoses: Prévalence, causes et facteurs pré-dictifs. Tunisie Médicale, 80, 21-25.
[36] Trinchet, J.C. (2002) Histoire naturelle de l’infection par le virus de l’hépatite C. Gastroentérologie Clinique et Biologique, 26, B144-B153.
[37] Bustamante, J., Rimola, A., Ventura, P.J., Navasa, M., Cirera, I., Reggiardo, V., et al. (1999) Prognostic Significance of Hepatic Encephalopathy in Patients with Cirrhosis. Journal of Hepatology, 30, 890-895.

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