부산대학교 도서관

Chantelli Iamblaudiot Razafindrazoto,1 Nitah Harivony Randriamifidy,1 Behoavy Mahafaly Ralaizanaka,2 Jean Tsitamita Andrianoelison,1 Haga Tsilavo Ravelomanantsoa,1 Mialitiana Rakotomaharo,1 Domoina Harivonjy Hasina Laingonirina,1 Sonny Maherison,1 Jolivet Auguste Rakotomalala,3 Anjaramalala Sitraka Rasolonjatovo,1 Andry Lalaina Rinà Rakotozafindrabe,1 Tovo Harimanana Rabenjanahary,1 Soloniaina Hélio Razafimahefa,2 Rado Manitrala Ramanampamonjy1 1Gastroenterology Unit, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar; 2Hepato-Gastroenterology Unit, University Hospital Andrainjato, Fianarantsoa, Madagascar; 3Hepato-Gastroenterology Unit, University Hospital Mahavoky Atsimo, Mahajanga, MadagascarCorrespondence: Chantelli Iamblaudiot Razafindrazoto, Gastroenterology Unit, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar, Email iamblaudiotchantelli@yahoo.comBackground: 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.Patients and Methods: 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.Results: 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).Conclusion: 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.Keywords: risk factors, in-hospital mortality, liver cirrhosis, Madagascar