‘One size does not fit all’: Cirrhosis care access, mortality vary widely worldwide
Click Here to Manage Email Alerts
LONDON — Cirrhosis severity, infections and mortality outcomes were worse for patients in low to middle-income countries, due in part to poor access to liver transplant and ICU facilities, according to data presented here.
“We have health care disparities as well as differing populations and diseases that cause cirrhosis around the world,” Jasmohan S. Bajaj, MD, associate professor of medicine in the division of gastroenterology, hepatology and nutrition at Virginia Commonwealth University, told Healio. “Current data usually focus on few regions rather than providing a global perspective; this has implications for generalizability.”
During his presentation at the International Liver Congress, Bajaj noted that “the etiologies of liver disease, population characteristics and availability of resources differ among sites. In addition, equity and reduction of disparities requires us to be aware of resources and population differences between sites.”
To assess determinants of inpatient mortality and organ dysfunction, Bajaj and colleagues enrolled 1,383 adult patients with chronic liver disease/cirrhosis from 49 centers across the world. Nearly 40% of patients were from high-income countries while the remainder were from low to middle-income countries.
To maintain equity in their analysis, the researchers limited the number of patients to 50 individuals per site. Patient data, including admission variables, hospital course and inpatient outcomes were documented, with specific focus on mortality and organ dysfunction.
According to researchers, within the prior 6 months, 51% of patients experienced hospitalizations, 25% had infections, 32% had hepatic encephalopathy (HE), 23% had acute kidney injury (AKI), 15% had large volume paracentesis, 8% had hydrothorax and 4% had hepatocellular carcinoma. The leading etiologies were alcohol (46%), followed by nonalcoholic steatohepatitis (23%) and hepatitis B (13%) and hepatitis C (11%) infections.
Bajaj and colleagues determined that, once admitted to the hospital, 25% of cohort patients required an ICU transfer, 46% developed AKI, 15% developed grade 3 to 4 HE, 14% developed shock, 13% required ventilation and 13% developed nosocomial infections. The researchers also recorded an inpatient mortality rate of 15% and an inpatient transplant rate of 3%.
“We found that in addition to liver-related clinical variables, location of the patient in low to middle-income countries with implied lack of access to health care is a major determinant of outcomes,” Bajaj told Healio. “These outcomes are inpatient organ failures, death as well as 30-day mortality and readmissions. [Additionally,] 30-day readmission was lower in low to middle-income vs. high-income countries, since a larger proportion of patients in low to middle-income countries either died during the hospitalization or after discharge. This could be due to lower ICU and liver transplant facilities or access.”
Bajaj further noted that liver-related and unrelated factors and regional variations are essential to defining critical care goals and outcome models among inpatients with cirrhosis across borders.
“A global perspective in management of cirrhosis is needed and one size does not fit all,” Bajaj said. “There are major health care disparities in management of cirrhosis, and policy makers, investigators and clinicians should be aware of potential lack of access to lifesaving equipment, procedures and facilities across the world.”
Collapse
Bajaj JS. Abstract OS063. Presented at: International Liver Congress; June 22-26, 2022; London (hybrid meeting).
Read more about
Click Here to Manage Email Alerts