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. 2022 Sep 13;17(9):e0274544.
doi: 10.1371/journal.pone.0274544. eCollection 2022.

Mortality burden due to liver cirrhosis and hepatocellular carcinoma in Ghana; prevalence of risk factors and predictors of poor in-hospital survival

Yvonne A Nartey  1   2 , Samuel O Antwi  3 , Ansumana S Bockarie  4 , Lindsey Hiebert  5 , Henry Njuguna  5 , John W Ward  5 , Yaw A Awuku  6 , Amelie Plymoth  1 , Lewis R Roberts  7
Affiliations

Mortality burden due to liver cirrhosis and hepatocellular carcinoma in Ghana; prevalence of risk factors and predictors of poor in-hospital survival

Yvonne A Nartey et al. PLoS One. .

Abstract

Liver-related diseases, including liver cirrhosis and hepatocellular carcinoma (HCC), are significant causes of mortality globally. Specific causes and predictors of liver-related mortality in low resource settings require assessment to help inform clinical decision making and develop strategies for improved survival. The objectives of this study were to determine the proportion of liver-related deaths associated with liver cirrhosis, HCC, and their known risk factors, and secondly to determine predictors of in-hospital mortality among cirrhosis and HCC patients in Ghana. We first performed a cross-sectional review of death register entries from 11 referral hospitals in Ghana to determine the proportion of liver-related deaths and the proportion of risk factors associated with these deaths. Secondly, we conducted a retrospective cohort review of 172 in-patient liver cirrhosis and HCC cases admitted to a tertiary referral centre and determined predictors of in-hospital mortality using binary logistic regression and Kaplan-Meier survival analysis. In total, 8.8% of deaths in Ghanaian adults were due to liver-related causes. The proportion of liver-related deaths attributed to HBV infection was 48.8% (95% CI: 45.95-51.76), HCV infection was 7.0% (95% CI: 5.58-8.45), HBV-HCV co-infection 0.5% (95% CI: 0.1-0.9) and alcohol was 10.0% (95% CI: 8.30-11.67). Of 172 cases of HCC and liver cirrhosis, the in-patient mortality rate was 54.1%. Predictors of in-patient mortality in cirrhotic patients were increasing WBC (OR = 1.14 95% CI: 1.00-1.30) and the revised model for end-stage liver disease with sodium (MELD-Na) score (OR = 1.24 95% CI: 1.01-1.54). For HCC patients, female sex (OR = 3.74 95% CI: 1.09-12.81) and hepatic encephalopathy (grade 1) were associated with higher mortality (OR = 5.66 95% CI: 1.10-29.2). In conclusion, HBV is linked to a high proportion of HCC-related deaths in Ghana, with high in-hospital mortality rates that require targeted policies to improve survival.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Proportion of risk factors associated with deaths from liver-related diseases reported in the Ghana District Health Information Management System (DHIMS2) between 2018–2020 from seven referral centres in Ghana with 95% CI.
Abbreviations: CLD- Chronic Liver Disease, HCC- Hepatocellular Carcinoma.
Fig 2
Fig 2. Proportion of risk factors associated with death from hepatocellular carcinoma, liver cirrhosis, and chronic liver disease in 11 referral hospitals in Ghana.
Abbreviations: HBV- Hepatitis B Virus, HCV- Hepatitis C Virus.
Fig 3
Fig 3. Proportion of risk factors for cirrhosis and HCC in patients seen at a tertiary referral centre in Ghana.
Abbreviations: HBV- Hepatitis B Virus, HCV- Hepatitis C Virus, NAFLD- Non-alcoholic Fatty Liver Disease.
Fig 4
Fig 4. Kaplan-Meier survival curves comparing in-patient survival probabilities between liver cirrhosis patients and HCC patients.
Fig 5
Fig 5. Kaplan-Meier survival curves comparing in-patient survival by MELD-Na score.
Fig 6
Fig 6. Kaplan-Meier survival curves comparing in-patient survival by Child-Pugh score.
See this image and copyright information in PMC

References

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