Patterns and outcomes of hepatic decompensation among hospitalized patients with cirrhosis in two referral hospitals in Rwanda

Abstract

Liver cirrhosis represents a growing global public health challenge, with increasing mortality rates and significant morbidity. In Africa, and specifically Rwanda, the burden is exacerbated by a high prevalence of hepatitis B and C infections, limited healthcare infrastructure, and complexity of disease management. The aim of this study was to explore the patterns and clinical outcomes of cirrhosis decompensation among adult cirrhotic patients in two referral hospital in Rwanda. An ambidirectional cohort study was conducted over 18 months across two Rwandan referral hospitals, involving adult cirrhotic patients. The research utilized a comprehensive data collection tool, employing non-probabilistic sampling with retrospective and prospective components. The primary outcome was the causes decompensation and the secondary was in-hospital mortality. Data were analyzed using SPSS version 25, applying descriptive, and inferential statistics to examine the factors associated with decompensation and in-hospital mortality s at 95% confidence level, accepting 0.05 margin of errors. The study encompassed 162 cirrhotic patients with a mean age of 55.48 years (± 16.06), predominantly males (63.6%). Hepatitis C emerged as the primary risk factor associated with cirrhosis (45%), followed by hepatitis B (23.5%). Bivariate analysis revealed that the cause of decompensation (p < 0.001), endoscopic screening/therapeutic intervention (p < 0.001), and beta-blockers prophylaxis (p < 0.001) were statistically and significantly associated with patient survival during a hospital stay (p-value trend < 0.001). In multivariate analysis, beta-blocker prophylaxis demonstrated a significant protective effect [aOR: 0.256, 95% CI: 0.095–0.688, p = 0.007]. This study reveals the critical role of beta-blockers prophylaxis, and specific form of decompensation in cirrhotic patient outcomes. The findings emphasize the need for comprehensive clinical management in cirrhosis.