RESUMEN
INTRODUCTION AND AIM: Considered as a healthcare quality indicator, hospital readmissions in decompensated cirrhosis predispose the patients and the society to physical, social and economic distresses. Few studies involving North American cohorts have identified different predictors. The aim of this study was to determine and validate the predictors of 1-month and 3-months readmission in an Asian cohort. MATERIAL AND METHODS: We prospectively studied 281 hospitalised patients with decompensated cirrhosis at a large tertiary care public hospital in India between August 2014 and August 2016 and followed them for 3 months. Data regarding demographic, laboratory and disease related risk factors were compiled. We used multivariate logistic regression to determine predictors of readmission at 1-month and 3-months and receiver operating curves (ROC) for significant predictors to obtain the best cut-offs. RESULTS: 1-month and 3-months readmission rates in our study were 27.8% and 42.3%, respectively. Model for End stage Liver Disease (MELD) score at discharge (OR:1.24, p < 0.001) and serum sodium (OR:0.94, p-0.039) independently predicted 1-month and MELD score (OR:1.11, p-0.003), serum sodium (OR:0.94, p-0.027) and male gender (OR:2.19, p-0.008) independently predicted 3-months readmissions. Neither aetiology nor complications of cirrhosis emerged as risk factors. MELD score >14 at discharge and serum sodium < 133 mEq/L best predicted readmissions; MELD score being a better predictor than serum sodium (p - 0.0001). CONCLUSIONS: High rates of early and late readmissions were found in our study. Further, this study validated readmission predictors in Asian patients. Structured interventions targeting this risk factors may diminish readmissions in decompensated cirrhosis.
Asunto(s)
Cirrosis Hepática/epidemiología , Readmisión del Paciente/tendencias , Medición de Riesgo/métodos , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Incidencia , India/epidemiología , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/terapia , Masculino , Persona de Mediana Edad , Alta del Paciente/tendencias , Pronóstico , Estudios Prospectivos , Curva ROC , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de TiempoRESUMEN
ABSTRACT Introduction and aims. Drug-induced liver injury (DILI) is rare; however, it is one of the important causes of acute liver failure which results in significant morbidity or mortality. Material and methods. Patients with suspected DILI were enrolled based on predefined criteria and followed up for at least 6 months or until normalization of liver tests. Causality assessment was done by applying the Roussel Uclaf Causality Assessment Method model. Results. We collected data from 82 individuals diagnosed with DILI at our hospital from 2014 through 2015 (41 men; median age, 38 years). The most commonly implicated drugs were antitubercular therapy (ATT) (49%), antiepileptic drugs (12%), complementary and alternative medicine (CAM) in 10%, antiretroviral drugs (9%) and non-steroidal anti-inflammatory drugs (6%). 8 out of 13 deaths were liver related. Also, liver related mortality was significantly higher for ATT DILI (17.5%) vs. those without (2.4%) (P = 0.02). There was no significant difference in overall as well as liver related mortality in hepatocellular, cholestatic or mixed pattern of injury. Laboratory parameters at one week after discontinuation of drug predicted mortality better than those at the time of DILI recognition. On multivariate logistic regression analysis, jaundice, encephalopathy, MELD (Model for end stage liver disease) score and alkaline phosphatase at one week, independently predicted mortality. Conclusion. DILI results in significant overall mortality (15.85%). ATT, anti-epileptic drugs, CAM and antiretroviral drugs are leading causes of DILI in India. Presence of jaundice, encephalopathy, MELD score and alkaline phosphatase at one week are independent predictors of mortality.(AU)
Asunto(s)
Humanos , Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Antituberculosos/efectos adversos , Estudios de Evaluación como Asunto , IndiaRESUMEN
INTRODUCTION AND AIMS: Drug-induced liver injury (DILI) is rare; however, it is one of the important causes of acute liver failure which results in significant morbidity or mortality. MATERIAL AND METHODS: Patients with suspected DILI were enrolled based on predefined criteria and followed up for at least 6 months or until normalization of liver tests. Causality assessment was done by applying the Roussel Uclaf Causality Assessment Method model. RESULTS: We collected data from 82 individuals diagnosed with DILI at our hospital from 2014 through 2015 (41 men; median age, 38 years). The most commonly implicated drugs were antitubercular therapy (ATT) (49%), antiepileptic drugs (12%), complementary and alternative medicine (CAM) in 10%, antiretroviral drugs (9%) and non-steroidal anti-inflammatory drugs (6%). 8 out of 13 deaths were liver related. Also, liver related mortality was significantly higher for ATT DILI (17.5%) vs. those without (2.4%) (P = 0.02). There was no significant difference in overall as well as liver related mortality in hepatocellular, cholestatic or mixed pattern of injury. Laboratory parameters at one week after discontinuation of drug predicted mortality better than those at the time of DILI recognition. On multivariate logistic regression analysis, jaundice, encephalopathy, MELD (Model for end stage liver disease) score and alkaline phosphatase at one week, independently predicted mortality. CONCLUSION: DILI results in significant overall mortality (15.85%). ATT, anti-epileptic drugs, CAM and antiretroviral drugs are leading causes of DILI in India. Presence of jaundice, encephalopathy, MELD score and alkaline phosphatase at one week are independent predictors of mortality.
Asunto(s)
Enfermedad Hepática Inducida por Sustancias y Drogas/mortalidad , Centros de Atención Terciaria , Adolescente , Adulto , Anciano , Fosfatasa Alcalina/sangre , Antirretrovirales/efectos adversos , Anticonvulsivantes/efectos adversos , Antituberculosos/efectos adversos , Biomarcadores/sangre , Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Distribución de Chi-Cuadrado , Pruebas Enzimáticas Clínicas , Femenino , Encefalopatía Hepática/inducido químicamente , Encefalopatía Hepática/mortalidad , Humanos , India , Ictericia/inducido químicamente , Ictericia/mortalidad , Pruebas de Función Hepática , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Factores de Tiempo , Adulto JovenRESUMEN
Background - Hepatitis B virus and hepatitis C virus are among the principal causes of severe liver disease. There is limited data of epidemiology of Hepatitis B in community, more so in rural population. Objective - To find the prevalence of hepatitis B and C infection in community and study the risk factors for their transmission. Methods - This was a community based cross sectional study. A total of 1833 randomly selected subjects from a rural area were interviewed for risk factors for transmission and tested for markers of hepatitis B and hepatitis C infection. All the positive card tests were confirmed by ELISA. Results - Out of 2400 subjects, rate for participation was 76.38%. None of the subjects was positive for anti hepatitis C virus antibody. Point prevalence for HBsAg positivity was 0.92. Being healthcare worker and having tattoo were significantly associated with HBsAg positive results. Nose and ear piercing was reported by almost. History of blood or blood product transfusion, I/V drug abuse, multiple sexual partners, unsafe Injections, hemodialysis and any h/o surgery was not associated with HBsAg positivity. Conclusion - Health care workers are at high risk for transmission of hepatitis B. Educating common people regarding mode of transmission of Hepatitis B and C will help to reduce their transmission.
Contexto - O vírus da hepatite B e o vírus da hepatite C estão entre as principais causas de doença grave do fígado. Há dados limitados de epidemiologia da hepatite B na comunidade observada, mais ainda na população rural. Objetivo - Encontrar a prevalência de infecção de hepatite B e C em uma comunidade da India e pesquisar os fatores de risco para sua transmissão. Métodos - Feito estudo de corte transversal em uma comunidade. Um total de 1833 sujeitos selecionados aleatoriamente em uma área rural foram entrevistados para fatores de risco para transmissão e testados para marcadores da infecção por hepatite B e C. Todos os testes positivos de cartão foram confirmados por ELISA. Resultados - Dos 2400 pacientes objetivados houve uma taxa de participação de 76.38%. Nenhum dos indivíduos foi positivo para anticorpo anti vírus da hepatite C. A prevalência pontual para a positividade do HBsAg foi de 0,92. Ser trabalhador na área de saúde e ter tatuagem foram significativamente associados com resultados positivos de HBsAg. "Piercing" em nariz e orelha foram relatados por quase todos. História de transfusão de sangue ou uso de hemoderivados, abuso de drogas via endovenosa, múltiplos parceiros sexuais, injeções inseguras, hemodiálise e história prévia de cirurgia, não estiveram associadas à positividade do HBsAg. Conclusão - Os trabalhadores de saúde estão em alto risco para a transmissão de hepatite B. Educar pessoas comuns sobre o modo de transmissão de hepatite B e C ajudará a reduzir a sua transmissão.
Asunto(s)
Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Hepacivirus/inmunología , Virus de la Hepatitis B/inmunología , Hepatitis B/epidemiología , Hepatitis C/epidemiología , Estudios Transversales , Ensayo de Inmunoadsorción Enzimática , Anticuerpos contra la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/sangre , Hepatitis B/diagnóstico , Anticuerpos contra la Hepatitis C/sangre , Hepatitis C/diagnóstico , India/epidemiología , Prevalencia , Factores de Riesgo , Población Rural , Estudios SeroepidemiológicosRESUMEN
BACKGROUND: Hepatitis B virus and hepatitis C virus are among the principal causes of severe liver disease. There is limited data of epidemiology of Hepatitis B in community, more so in rural population. OBJECTIVE: To find the prevalence of hepatitis B and C infection in community and study the risk factors for their transmission. METHODS: This was a community based cross sectional study. A total of 1833 randomly selected subjects from a rural area were interviewed for risk factors for transmission and tested for markers of hepatitis B and hepatitis C infection. All the positive card tests were confirmed by ELISA. RESULTS: Out of 2400 subjects, rate for participation was 76.38%. None of the subjects was positive for anti hepatitis C virus antibody. Point prevalence for HBsAg positivity was 0.92. Being healthcare worker and having tattoo were significantly associated with HBsAg positive results. Nose and ear piercing was reported by almost. History of blood or blood product transfusion, I/V drug abuse, multiple sexual partners, unsafe Injections, hemodialysis and any h/o surgery was not associated with HBsAg positivity. CONCLUSION: Health care workers are at high risk for transmission of hepatitis B. Educating common people regarding mode of transmission of Hepatitis B and C will help to reduce their transmission.