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Predictors of mortality in patients under treatment for chronic hepatitis B in Ethiopia: a prospective cohort study
Hailemichael Desalegn1, Hanna Aberra2, Nega Berhe3,4
1Medical Department, St. Paul's Hospital Millennium Medical College, Po. Box 1271, Addis Ababa, Ethiopia. hailed2003@yahoo.com.
Insights
Antiviral treatment for chronic hepatitis B (CHB) in sub-Saharan Africa is limited. Decompensated cirrhosis, low BMI, and older age predict mortality in CHB patients starting tenofovir treatment.
Area of Science:
- Hepatology and Viral Hepatitis
- Public Health and Epidemiology
- Clinical Pharmacology
Background:
- Antiviral treatment for chronic hepatitis B (CHB) is scarce in sub-Saharan Africa, limiting knowledge of patient prognosis.
- This study addresses the lack of data on outcomes for African CHB patients initiating antiviral therapy.
Purpose of the Study:
- To identify predictors of mortality in a large cohort of CHB patients receiving tenofovir disoproxil fumarate in Ethiopia.
- To understand the prognostic factors influencing survival in this understudied population.
Main Methods:
- Analysis of 276 CHB patients treated with tenofovir disoproxil fumarate from March 2015 to August 2017 in Ethiopia.
- Mortality ascertained via hospital records and telephone interviews; decompensated cirrhosis defined by clinical/ultrasonographic evidence of ascites.
- Cox proportional hazard models employed to determine independent predictors of mortality.
Main Results:
- Thirty-five patients (12.7%) died during follow-up, with 33 having decompensated cirrhosis at baseline.
- Key predictors of mortality included decompensated cirrhosis (AHR 23.68), low body mass index <18.5 kg/m2 (AHR 3.65), and older age (AHR 1.06 per year).
- Estimated survival rates were 90.3% at 6 months, 88.2% at 12 months, and 86.3% at 24 months.
Conclusions:
- Decompensated cirrhosis, low body mass index, and older age are significant independent predictors of mortality in African CHB patients on tenofovir.
- Enhancing access to and earlier initiation of antiviral therapy are crucial for improving survival outcomes in this population.
Background:
Antiviral treatment for chronic hepatitis B (CHB) is largely unavailable in sub-Saharan Africa; hence, little is known about the prognosis after initiating treatment in African CHB patients. In this study we aimed to assess predictors of mortality in one of the largest CHB cohorts in sub-Saharan Africa.
Methods:
Two-hundred-and-seventy-six CHB patients who started treatment with tenofovir disoproxil fumarate at a public hospital in Ethiopia between March 18, 2015, and August 1, 2017, were included in this analysis. Patients were followed up until October 1, 2017, and deaths were ascertained through hospital records and telephone interview with relatives. Decompensated cirrhosis was defined as current or past evidence of ascites, either by clinical examination or by ultrasonography. Cox proportional hazard models were used to identify independent predictors of mortality.
Results:
Thirty-five patients (12.7%) died during follow-up, 33 of whom had decompensated cirrhosis at recruitment. The median duration from start of treatment to death was 110 days (interquartile range 26-276). The estimated survival was 90.3, 88.2 and 86.3% at 6, 12 and 24 months of follow-up, respectively. Independent predictors of mortality were decompensated cirrhosis (adjusted hazard ratio [AHR] 23.68; 95% CI 3.23-173.48; p = 0.002), body mass index < 18.5 kg/m2 (AHR 3.65; 95% CI 1.73-7.72; p = 0.001) and older age (per 1-year increment; AHR 1.06; 95% CI 1.02-1.10; p = 0.007).
Conclusions:
Decompensated cirrhosis, low body mass index and older age were independent predictors of mortality. Improved access to antiviral treatment and earlier initiation of therapy could improve the survival of African CHB patients.
Trial Registration:
NCT02344498 ( ClinicalTrials.gov identifier). Registered 16 January 2015.
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