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ORIGINAL ARTICLE J Nepal Med Assoc 2023;61(258):115-118

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doi: 10.31729/jnma.8016

Liver Cirrhosis among Young Adults Admitted to the Department


of Gastroenterology in a Tertiary Care Centre: A Descriptive Cross-
sectional Study
Mohan Bhusal,1 Rahul Pathak,1 Brindeswari Kafle Bhandari,1 Anurag Jha,1 Rabin Hamal,1 Dinesh Koirala,1
Manoj Lamsal,1 Pradip Kumar Kafle1
1
Department of Gastroenterology, Tribhuwan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.

ABSTRACT

Introduction: Cirrhosis in young adults is an important health problem worldwide and is a common
disease. Patients usually present late in a decompensated state with varied complications. However,
national data on the exact burden of the disease is lacking. The aim of this study was to find out the
prevalence of liver cirrhosis among young adults admitted to the Department of Gastroenterology
in a tertiary care centre.

Methods: A descriptive cross-sectional study was done among patients admitted to the Department
of Gastroenterology in a tertiary care centre between 25 November 2021 to 30 November 2022 after
receiving ethical approval from the Institutional Review Committee [Reference number: 227(6-11)
E2-078/079]. Convenience sampling was done. Point estimate and 95% Confidence Interval were
calculated.

Results: Among 989 patients, liver cirrhosis in young adults was seen in 200 (20.22%) (18.12-22.32,
95% Confidence Interval). Chronic alcohol use was the primary cause of cirrhosis seen in 164 (82%)
cases. The most typical presenting symptom was abdominal distension seen in 187 (93.50%) patients.
The most frequent complication was ascites seen in 184 (92%) patients. The most frequent endoscopic
finding was gastro-oesophagal varices seen in 180 (90%) patients. There were 145 (72.50%) men and
55 (27.50%) women.

Conclusions: The prevalence of liver cirrhosis in young adults was found to be lower than the other
studies done in similar settings.

Keywords: ascites; liver cirrhosis; prevalence.

INTRODUCTION

Liver cirrhosis refers to a disorder that alters the unknown.3 Early interventions and preventions are
overall typical architecture of the liver. Globally, the required to stabilize disease progression and to avoid
majority of instances are ascribed to non-alcoholic or delay clinical decompensation and the need for liver
fatty liver disease, viral hepatitis, or excessive alcohol transplantation.4
usage.1 Depending on the aetiology and whether portal
hypertension or hepatocellular damage predominates, The aim of this study was to find out the prevalence
the clinical appearance of cirrhosis differs. However, of liver cirrhosis among young adults admitted to
even in the absence of any clear clinical symptoms, the Department of Gastroenterology in a tertiary care
substantial liver damage may be present.2 centre.
______________________________________
Various causes of cirrhosis in adults have been studied
but the aetiology of cirrhosis in young adults less Correspondence: Dr Rahul Pathak, Department of
Gastroenterology, Tribhuwan University Teaching Hospital,
than or equal to 40 years has not been well studied, Maharajgunj, Kathmandu, Nepal. Email: dr.rahuliom@gmail.
and the incidence of cryptogenic cirrhosis remains com, Phone: +977-9851113793.

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Bhusal et al. Liver Cirrhosis among Young Adults Admitted to the Department of Gastroenterology in a Tertiary Care Centre: A Descriptive...

METHODS Model for End Stage Liver Disease (MELD) scores


were calculated for all the patients. Information was
A descriptive cross-sectional study was done gathered using a standardized proforma.
among young adults admitted to the Department of
Gastroenterology in Tribhuvan University Teaching Data collected were entered and analyzed using IBM
Hospital between 25 November 2021 to 30 November SPSS Statistics version 20.0. Point estimate and 95%
2022 after receiving ethical approval from the CI were calculated.
Institutional Review Committee of same institute
[Reference number: 227(6-11)E2-078/079]. All patients RESULTS
admitted to the Gastroenterology ward of the hospital Among 989 patients, liver cirrhosis among young
aged >18 and ≤40 years were included in the study. adults was seen in 200 (20.22%) (18.12-22.32, 95% CI).
Patients who do not give informed consent were In a total of 200 cases, liver cirrhosis was seen in 145
excluded from the study. Informed consent was signed (72.50%) men and 55 (27.5%) women. The participants
and confidentiality of the information was ensured. ranged in age from 18 to 40 years, with mean age of
Convenience sampling was done. The sample size was 28.92±5.73 years. A total of 68 (34%) Brahmins made
calculated by using following formula: up the majority of the study group, followed by 42
pxq (21%) Khas, 25 (12.50%) Newar, 20 (10%) Madheshi,
n= Z2 x
e2 and 6 (3%) Tharus.
0.50 x 0.50
= 1.962 x
0.042 There were 73 (36.50%) farmers made up the research
group, which also included 56 (28%) retired people,
= 601 37 (18.50%) people who worked for the government,
Where, and 34 (17%) housewives. In this study 113 (56.50%)
n= minimum required sample size patients were from rural areas, while 87 (43.50%)
Z= 1.96 at a 95% Confidence Interval (CI) patients were from metropolitan areas. A total of 80
p= prevalence taken as 50% for maximum sample size (40%) patients were from a moderate socioeconomic
calculation class, 70 (35%) from a lower one and just 50 (25%)
q= 1-p from a higher one.
e= margin of error, 7%
Chronic alcohol use was the primary cause of cirrhosis
The calculated minimum required sample size 601. in 164 (82%) patients. Other causes were non-alcoholic
However, 989 patients were included in the study. steatohepatitis (NASH) and chronic viral hepatitis seen
in 20 (10%) cases and 12 (6%) cases respectively. The
Each patient was subjected to a detailed clinical remaining cases, 4 (2%) were labelled as cryptogenic
history regarding the duration of illness and (Figure 1).
symptoms. Predetermined proforma was used as the
tool for data collection. All patients were subjected
to detailed clinical and laboratory data including
demographics, and history of alcohol consumption,
medications, substance abuse, and other systemic
diseases. Various biochemical studies like alkaline
phosphatase (ALP), aspartate aminotransferase (AST),
alanine transaminase (ALT), serum total globulin/
gamma globulins, serology like antinuclear antibody
(ANA), anti-smooth muscle antibody (ASMA),
antimitochondrial Aantibody (AMA), immunoglobulin
A (IgA), tissue transglutaminase (tTG), liver-kidney
microsomal (LKM-1), viral hepatitis markers, HLA-DR3 Figure 1: Suspected causes in patients with cirrhosis
or DR4) and abdominal ultrasound was done for liver (n= 200).
and spleen size, parenchymal echogenicity, portal vein
diameter, and ascites. Serum ceruloplasmin, urinary Abdominal distension was the most frequent
copper levels and slit lamp examination for the Kayser- manifestation, occurring in 187 (93.50%) cases,
Fleischer ring were done when indicated.5 followed by anorexia 140 (70%), fatigue 120 (60%), and
vomiting 104 (52%). Ascites was clinically evident in
Each patient had undergone upper gastrointestinal 184 (92%) individuals. There were 108 (54%) individuals
(UGI) endoscopy and diagnostic findings were who had upper gastrointestinal bleeding. The other
documented. Child-Turcotte-Pugh (CTP) score and typical signs were icterus, followed by pallor, pedal

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Bhusal et al. Liver Cirrhosis among Young Adults Admitted to the Department of Gastroenterology in a Tertiary Care Centre: A Descriptive...

edema, and hair loss over the body (Table 1). DISCUSSION

Table 1. Symptomatology at presentation (n= 200). The prevalence of liver cirrhosis among young adults
Signs and symptoms n (%) was 20.22% which was high when compared to a
Abdominal distension 187 (93.50) similar study done in other tertiary care centres of
Anorexia 140 (70) Nepal,6 but lower to the similar studies done in Nepal.7,8
Fatigue 120 (60)
In the current investigation, alcoholic liver disease
Vomiting 104 (52)
was the most prevalent aetiology of cirrhosis and was
Dizziness 64 (32)
found in 164 (82%) individuals which was similar to
Fever 50 (25)
other studies.4,9,10 The most prevalent cause of cirrhosis
Altered sensorium 36 (18)
in Nepal is chronic alcohol use. Therefore, cirrhosis
Oliguria 12 (6)
cases are increasingly being detected in young
Ascites 184 (92)
people, as was shown in the current research, which
UGI bleed 108 (54)
may be related to early alcohol consumption and
Icterus 148 (74)
dependency. The prevalence of alcohol use, misuse,
Pallor 144 (72)
and dependency among the younger population is
Pedal oedema 120 (60)
increasing, which may be the cause of this condition.
Loss of body hair 118 (59)
Spider naevi 86 (43) In this study, 184 (92%) individuals had ascites
Palmar erythema 48 (24) followed by pallor in 144 (72%) and pedal edema in 120
Parotid enlargement 52 (26) (60%), icterus was seen in 148 (74%) patients. In this
Dyspnea 40 (20) research, 108 (54%) patients had upper gastrointestinal
bleeding. These results were similar to other studies.4,9
There were 108 (54%) individuals who had UGI
In the current study, the most frequent finding on UGI
bleeding. The most frequent endoscopic finding was
endoscopy was gastro-oesophageal varices, which
gastro-oesophagal varices, which were discovered in
were observed in 180 (90%) patients, followed by
180 (90%)patients, followed by portal gastropathy in
portal gastropathy in 150 (75%) patients which was
150 (75%) patients, peptic ulcers in 15 (7.50%) patients,
similar to other studies.9
gastro-duodenitis in 4 (2%) patients, Mallory Weiss
tears in 20 (10%) patients and GI malignancies in 2 The mean age of the patients from our study was
(1%) patients. similar to these studies.9 With regards to the gender-
wise distribution of the patients, our study showed
The participants were divided into groups based on
that ALD was more predominant in males which is
their CTP classifications. Most cases belong to CTP C
similar to other studies.4,9,10 The increased prevalence
120 (60%) patients (Figure 2).
of ethanol use among males compared to women
is most likely the cause of the male preponderance
over female in all investigations. Additionally, there
may be disparities in how the two sexes seek medical
attention.

In the present research, a total of 113 (56.5%) patients


came from rural regions which was less compare to
other studies.9 The CTP score of our study was similar
to the studies carried out at other tertiary centre.9 In
our investigation, ascites, which was discovered in 184
(92%) patients, was determined to be the most typical
complication of cirrhosis at presentation, followed by
UGI bleed in 108 (54%) patients. Rebleeding was seen in
Figure 2. Child-Turcotte-Pugh score of patients with 33 (16.5%) patients. Hepatic encephalopathy 36 (18%),
cirrhosis (n= 200). SBP 26 (13%), and HRS 22 (11%) followed. According
to one of the study, the most frequent complications
The most common complications was ascites seen were ascites in 78.6% of patients, variceal bleeding
in 184 (92%) of the patients. Hepatic encephalopathy in 43.4%, hepatic encephalopathy in 21.6%, SBP in
(HE) was seen in 36 (18%) cirrhotic patients, followed 4.2%, HRS in 2.7%, HCC in 1.3%, hypersplenism in
by spontaneous bacterial peritonitis (SBP) in 26 (13%) 0.4%, and sepsis in 12.8% of patients.9 These findings
patients, and hepatorenal syndrome (HRS) in 22 (11%) were consistent with those from our study. In some
patients.

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Bhusal et al. Liver Cirrhosis among Young Adults Admitted to the Department of Gastroenterology in a Tertiary Care Centre: A Descriptive...

investigations, SBP incidences between 10% and 30% CONCLUSIONS


higher than ours have been reported.10-12 According to
a recent study, hospitalized patients had a prevalence The prevalence of liver cirrhosis in young adults in our
of SBP of 24.7% and 34.9%, respectively.13,14 study was found to be lower than in studies done in
similar settings. People need to be made aware of the
The results of the study cannot be generalised as negative consequences of frequent alcohol use. Early
the population under study is limited to patients diagnosis of viral hepatitis and alcoholic liver illnesses
admitted to one tertiary care centre. Also, because provides survival advantages, and their treatment may
of the descriptive nature of this study, an association lessen the burden of cirrhosis. In instances of cirrhosis
between exposure and outcome cannot be made in that have already progressed, necessary management
this study design and risk factors cannot be made out. and therapy, the avoidance of complications, and
A larger study conducted at different centres should routine monitoring and follow-ups may all lower
be conducted to better understand the exact burden of morbidity and death.
liver cirrhosis in young adults.
Conflict of Interest: None.

REFERENCES
1. Pinzani M, Rosselli M, Zuckermann M. Liver cirrhosis. 9. Bhattacharyya M, Barman NN, Goswami B. Clinical profile
Best Pract Res Clin Gastroenterol. 2011 Apr;25(2):281-90. of cirrhosis of liver in a tertiary care hospital of Assam, North
[PubMed | Full Text | DOI] East India. IOSR Journal of Dental and Medical Sciences.
2016;15(1):21–7. [Full Text]
2. de Franchis R, Primignani M. Natural history of portal
hypertension in patients with cirrhosis. Clin Liver Dis. 2001 10. Qua CS, Goh KL. Liver cirrhosis in Malaysia: peculiar
Aug;5(3):645-63. [PubMed | Full Text | DOI] epidemiology in a multiracial Asian country. J Gastroenterol
Hepatol. 2011 Aug;26(8):1333-7. [PubMed | Full Text | DOI]
3. Olave MC, Gurung A, Mistry PK, Kakar S, Yeh M, Xu M, et
al. Jain D. Etiology of cirrhosis in the young. Hum Pathol. 11. Sarin SK, Chari S, Sundaram KR, Ahuja RK, Anand BS, Broor
2020 Feb;96:96-103. [PubMed | Full Text | DOI] SL. Young v adult cirrhotics: a prospective, comparative
analysis of the clinical profile, natural course and survival.
4. Maskey R, Karki P, Ahmed SV, Manandhar DN. Clinical
Gut. 1988 Jan;29(1):101-7. [PubMed | Full Text | DOI]
profile of patients with cirrhosis of liver in a tertiary
care hospital, Dharan, Nepal. Nepal Med Coll J. 2011 12. Rimola A, Garcia-Tsao G, Navasa M, Piddock LJ, Planas R,
Jun;13(2):115-8. [PubMed | Full Text] Bernard B, et al. Diagnosis, treatment and prophylaxis of
spontaneous bacterial peritonitis: a consensus document.
5. Smith A, Baumgartner K, Bositis C. Cirrhosis: Diagnosis and
International Ascites Club. J Hepatol. 2000 Jan;32(1):142-53.
Management. Am Fam Physician. 2019 Dec 15;100(12):759-70.
[PubMed | Full Text | DOI]
[PubMed | Full Text]
13. Syed VA, Ansari JA, Karki P, Regmi M, Khanal B.
6. Chaudhary A, Chaudhary AK, Chaudhary A, Bhandari A,
Spontaneous bacterial peritonitis (SBP) in cirrhotic ascites:
Dahal S, Bhusal S. Alcoholic liver disease among patients
a prospective study in a tertiary care hospital, Nepal.
admitted to the department of internal medicine of a tertiary
Kathmandu Univ Med J (KUMJ). 2007 Jan-Mar;5(1):48-59.
care centre: A descriptive cross-sectional study. J Nepal Med
[PubMed | Full Text]
Assoc. 2022 Apr 15;60(248):340-3. [PubMed | Full Text |
DOI] 14. Jain AP, Chandra LS, Gupta S, Gupta OP, Jajoo UN, Kalantri
SP. Spontaneous bacterial peritonitis in liver cirrhosis with
7. Mishra AK, Shrestha P, Bista N, Bhurtel P, Bhattarai S,
ascites. J Assoc Physicians India. 1999 Jun;47(6):619-21.
Thakali K, et al. Pattern of liver diseases. J Nepal Health Res
[PubMed | Full Text]
Counc. 2009;7(1):14-8. [Full Text]

8. Rizal S, Joshi BR, Singh AG. Burden of alcoholic liver disease


in a tertiary care center: A descriptive cross-sectional study.
J Nepal Med Assoc. 2019 Sep-Oct;57(219):307-10. [PubMed |
Full Text | DOI]

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