Predictors of outcome among patients with obstructive jaundice at Bugando Medical Centre in north-western Tanzania

Abstract

Despite recent advances both in preoperative diagnosis and postoperative care, obstructive jaundice still contributes significantly to high morbidity and mortality. A prospective study was undertaken to identify predictors of outcome among patients with obstructive jaundice at Bugando Medical Centre in north-western Tanzania. A total of 138 patients were studied. The male to female ratio was 1:1.6. The median age of patients was 58 years. Patients with malignant obstructive jaundice were older than those of benign type (P < 0.001). Ca head of pancreas (65.1%) was the commonest malignant cause of jaundice where as choledocholithiasis (51.9%) was the commonest benign cause. Twelve (9.7%) patients were HIV positive with a median CD 4+ count of 342 cells/l. A total of 130 (94.2%) patients underwent surgical treatment and the remaining 8 (5.8%) patients were unfit for surgery. The complication rate was 30.4% mainly due to surgical site infections and it was significantly influenced by malignant causes, WBC count > 10 X 109/l and HIV infection with low CD4 ( 200 cells/l) (p < 0.0001). The median hospital stay and mortality rate were 18 days and 20.3%, respectively. A low haematocrit and presence of postoperative complications were the main predictors of the hospital stay (P < 0.001), whereas age > 60 years, prolonged duration of jaundice, malignant causes, high bilirubin levels, HIV infection with low CD4+ count ( 200 cells/l) and presence of postoperative complications significantly predicted mortality (P< 0.001). In conclusion, our study highlighted the important factors that predict the outcome of patients presenting with obstructive jaundice at BMC; therefore attention should be focused to these factors so as to improve the outcome of these patients.

Etiology, Clinical Presentations, and Short-Term Treatment Outcomes of Extrahepatic Obstructive Jaundice in South-Western Uganda

“…Biliary stones were the most common cause of biliary obstruction among the age group of 36–50 years with predilection for male gender in this study. However the prevalence was more in females in other studies in Ethiopia, Tanzania, Italy, and the USA 7 , 17–19 . Estrogen causes super-saturation of biliary cholesterol due to hepatic hypersecretion, potentiating nucleation of cholesterol monohydrate crystals.…”

“…Predictors of poor outcome are long duration of jaundice, malignant causes, and high bilirubin levels. 7 …”

Safety of Percutaneous Transhepatic Biliary Stenting in Patients with Obstructive Jaundice

“…This study showed that bulk of the cases with obstructive jaundice were secondary to malignant diseases (97%), which is in concordance with previous studies. [11][12][13][14][15][16] Only 3 out of the 102 patients presented with benign biliary strictures.…”

“…Previous studies show pancreatic carcinoma to be the leading cause of biliary obstruction. [11][12][13][14][15][16] A study performed by Sharma et al showed CA gall bladder to be the leading cause of obstructive jaundice. 11 The overall complication rate was 29.4% which is higher than the previously reported 7% by Liu et al 8 Previously, in the local population the overall complication rate was reported as 41% by Haq et al which was markedly higher than the present figure.…”

Geriatrik popülasyonda kolestatik karaciğer hastalıklarında etiyoloji ve tanısal yaklaşım: 185 vakalık tek merkez deneyimi

“…Yine aynı çalışmada saptanan, ALP ve WBC yüksekliğinin de mortalite ile ilişkili olma durumu ise bizim çalışmamızda saptanmadı. Bilirübin düzeyi yüksekliğinin mortalite ile ilişkisi olduğuna dair literatürde pek çok çalışma bulunmaktadır(10,21).Hastalarımızın tamamına USG yapıldı ve %88.6'sında USG'nin obtrüksiyonu saptadığı ancak %47.7'sinde USG ile tanı konulabildiği gözlendi. Malign sebeplerin %50.7'sine, benign sebeplerin %45.8'ine USG ile tanı koyuduğu görüldü.…”