Access to care for cirrhosis, mortality varies widely around the world
Bajaj JS. Abstract OS063. Presented at: International Liver Congress; June 22-26, 2022; London (hybrid meeting).
Disclosures: Bajaj did not report any relevant financial information.
LONDON – Cirrhosis severity, infections and mortality outcomes were worse for patients in low- to middle-income countries, in part due to limited access to liver transplant facilities and intensive care, data shows. presented here.
“We have health care disparities and different 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 tends to focus on a few regions rather than providing a global perspective; this has implications for generalizability.
During his presentation at the International Liver Congress, Bajaj noted that “liver disease etiologies, population characteristics, and resource availability differ between sites. Additionally, equity and reducing disparities require us to be aware of resource and population differences between sites.
To assess the determinants of inpatient mortality and organ dysfunction, Bajaj and colleagues recruited 1,383 adult patients with chronic liver disease/cirrhosis from 49 centers around the world. Almost 40% of the patients were from high-income countries, while the rest were from low- and middle-income countries.
To maintain fairness in their analysis, the researchers limited the number of patients to 50 individuals per site. Patient data including admission variables, hospital pathway, and inpatient outcomes were documented, with particular emphasis on mortality and organ dysfunction.
According to the researchers, in the previous 6 months, 51% of patients were hospitalized, 25% had infections, 32% had hepatic encephalopathy (HE), 23% had acute renal failure (ARI), 15 % underwent large-volume paracentesis, 8% had hydrothorax, and 4% had hepatocellular carcinoma. The main etiologies were alcohol (46%), followed by non-alcoholic steatohepatitis (23%) and hepatitis B (13%) and hepatitis C (11%) infections.
Bajaj and colleagues determined that upon admission to hospital, 25% of patients in the cohort required transfer to intensive care, 46% developed ARI, 15% developed HE grade 3-4, 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, patient location in low- to middle-income countries with an implied lack of access to healthcare is a major determinant of outcomes,” Bajaj told Healio. “These outcomes are inpatient organ failure, death as well as 30-day mortality and readmissions. [Additionally,] 30-day readmission was lower in low- to middle-income countries than in high-income countries because a greater proportion of patients in low- to middle-income countries died during hospitalization or after discharge . This could be due to reduced facilities or access to intensive care and liver transplants.
Bajaj further noted that liver- and non-liver-related factors and regional variations are critical in defining critical care goals and outcome patterns in hospitalized patients with cirrhosis across borders.
“A holistic perspective in cirrhosis management is needed and one size does not fit all,” Bajaj said. “There are significant healthcare disparities in the management of cirrhosis, and policy makers, researchers and clinicians should be aware of the potential lack of access to vital equipment, procedures and facilities across the world. .”