Spectrum of Complications of Chronic Liver Disease in Gauhati Medical College and Hospital: A Hospital Based Study

Introduction: Cirrhosis of liver is defined anatomically as a diffuse process with nodule formation and fibrosis. Cirrhosis can remain as a silent disease until decompensation occurs. The clinical features are the result of the pathological changes and they mirror the severity of the liver disease and they are the same irrespective of the cause. Decompensated disease can result in complications such as as cites, spontaneous bacterial peritonitis, hepatic encephalopathy and variceal bleeding from portal hypertension. Data regarding the aetiology and the spectrum of clinical manifestations and complications of cirrhosis of liver is lacking from the North-East, India. Against this background, this present study was conducted. Aim: To determine the clinical spectrum of patients with chronic liver disease with reference to its aetiology, clinical manifestations, complications and causes of death in Gauhati Medical College and Hospital. Materials and Methods: The cross-sectional study was carried out with 200 enrolled chronic liver disease patients. A detailed history, clinical examination and a structured questionnaire were used to collect the data. Haematological, biochemical, radiological as well as endoscopic investigations were performed to evaluate various complications and manifestations. Data was analysed and expressed as percentage. Results: Alcohol was the most common aetiological factor for cirrhosis in 62.5% patients followed by Hepatitis B in 11%, Non Alcoholic Steato Hepatitis (NASH) in 9% and Hepatitis C in 3.5%. After performing the necessary investigations, the various complications of cirrhosis were coagulopathy in 83%, gastroesophagealvarix/ portal hypertensive gastropathy in 81%, ascites in 64%, hepatic encephalopathy in 51%, hypersplenism in 24%, hyponatremia in 17.18%, spontaneous bacterial peritonitis in 12.5%, hepatorenal syndrome in 4% and hepatocellular carcinoma in 2.5%. Ascitic fluid culture was positive in 9.3% patients with ascites, the most common organism grown in culture was E. Coli. 52.5% of the patients had Child Pugh C cirrhosis and 13% died during hospital stay. The most common cause of death was worsening hepatic encephalopathy in 50% followed by UGI bleed and sepsis. Conclusion: Chronic liver disease proves to be fatal if allowed to decompensate. Therefore, the best option is to prevent it or to control it at the earliest.