Chronic liver disease related mortality pattern in Northern Pakistan.

OBJECTIVE: To describe the mortality pattern pertaining to chronic liver disease (CLD) in Northern Pakistan.
DESIGN: descriptive study. PLACE AND DURATION OF STUDY: Shifa International Hospital, Islamabad, from August 01, 2001 to July 31, 2002. SUBJECTS AND METHODS: Twelve months admission data was reviewed from its computerized data base. All cases pertaining to medical mortality were reviewed. Out of these cases, patients of chronic liver disease were identified and their mode of presentation, severity of illness and etiology of their chronic liver disease were statistically analyzed.
RESULTS: There were a total of 8529 admissions in twelve months period from August 2001 to July 2002. There were 283 (3.31%) total deaths. Out of these, 160 deaths were pertaining to medical causes. Out of these medical cases, 33 (20.6%) patients had died of chronic liver disease. Other major causes of death were cerebro-vascular accident (18.7%), malignancy (18.1%) and acute myocardial infarction (10.6%). Out of 33 patients of CLD, 12 (36%) presented with acute gastrointestinal (GI) bleeding, 9 (27%) presented with ascites and 6(18%) presented with altered mental status due to hepatic encephalopathy. Rest of them had jaundice and fever as their initial presentation. Out of these 33 patients with CLD, 23 (70%) had hepatitis C virus (HCV) as cause of their liver disease, 4 (12%) had hepatitis B virus (HBV) infection, 3 (9%) had both hepatitis B and hepatitis C virus infections and 3 (9%) had no known cause of their chronic liver disease.
CONCLUSION: Chronic liver disease is a major cause of mortality in this part of Pakistan at a tertiary care hospital. HCV infection is the main cause of chronic liver disease followed by either HBV or a combination of these viruses. Major manifestations of CLD have been gastrointestinal bleeding, hepatic failure and portal hypertension.