Clinical profile of cirrhosis of liver in a tertiary care hospital of Assam, North East India

Abstract

Background: Epidemiology of liver cirrhosis suggests that although Hepatitis B and C are still common in developing countries, alcohol related cirrhosis is increasing. Rising trends in alcohol consumption in North East India, makes it essential to analyse the influence of these changes in the epidemiology of liver cirrhosis. Therefore, we aimed to study one thousand patients of cirrhosis of liver in North East India with reference to its demography, aetiology, clinical presentation, complications, prognostic features and short term mortality. Materials and methods: One thousand consecutively diagnosed adult cirrhosis patients were prospectively studied at the Department of Gastroenterology, Gauhati Medical College, a tertiary care hospital of North East India from June 2013- May 2014 for their clinical characteristics, prognosis and mortality at one month. Results: Commonest age group was 35-54years, mean age 45.8+ 10.4 years; M: F ratio 7.5:1. Symptoms were ascites (74.3%), gastrointestinal bleeding (43.4%), jaundice (36.3%), low urine output (31%) and altered sensorium in 23%. 37.1% patients had severe malnutrition. Aetiology were alcohol related (72.2%), HBV (8.9%), HCV (3.2%), Autoimmune Hepatitis (0.9%), Cryptogenic cirrhosis (17.2%) and NASH (1%). Complications were ascites (78.6%), variceal bleeding (43.4%), hepatic encephalopathy (21.6%), Spontaneous bacterial peritonitis 4.2%, Hepatorenal syndrome (2.7%) and Hepatocellular carcinoma (1.3%). 50% had Child C disease, 83% had MELD between 10-29 and APRI (AST to Platelet ratio index) >2.5 in 38.5% patients. Mortality was 7.8% and highest among alcoholic cirrhosis (6.8%). Conclusion: Cirrhosis is common in the most productive age and the commonest cause was alcohol cirrhosis which is preventable through proper education and legislation. Proper awareness will lead to prevention of long term morbidity.