Retrospective study of the clinical profile and prognostic indicators in patients of alcoholic liver disease admitted to a tertiary care teaching hospital in western Nepal

ABSTRACT

Alcohol is the most common substance abused in Nepal. Liver disease caused by alcohol abuse, including its end stage, cirrhosis, is a major health care problem, which is difficult to treat. To study the demographic profile, laboratory parameters, complications and their prognostic implications among patients of alcoholic liver disease [ALD]. Records of all patients of ALD admitted from January 1, 2005 to December 31, 2006 were studied and followed up to December 31, 2007. A total of 181 patients were analyzed. Their clinical profile and laboratory parameters were noted and analyzed using SPSS-10.0 software. Among the 181 patients, 80.7% were male, 30.9% were army/ex-army and 65.2% were documented smokers. The mean age of presentation was 52.08 years. Jaundice [57.5%] was the most common presentation followed by hepatomegaly [51.4%]. Hypoalbuminemia [50.3] followed by ascites [48.1] were common complications. Death occurred in 19.1% of the patients, the most common cause being hepatic encephalopathy [72.2%] followed by variceal bleeding and hepatorenal syndrome. Jaundice, ascites and hepatic encephalopathy at presentation and female sex were significantly associated with increased mortality along with discriminant score >32, aspartate aminotransferase [AST] Alanine aminotranferase [ALT] >/= 2, ultrasonography [USG]-proven cirrhosis, rise in prothrombin time >/= 5 s, total bilirubin >/= 4mg/dL and ESR >/= 34. ALD was predominantly seen among the productive age group with a high morbidity and mortality. Jaundice, ascites, hepatic encephalopathy at presentation and female sex are poor prognostic indicators along with discriminant score > 32, AST ALT >/= 2, USC-proven cirrhosis, coagulopathy, hyperbilirubenemia and high ESR