Analisis Faktor yang Mempengaruhi Mortalitas Pasien Sirosis Hepatis yang Dirawat di RS Adam Malik Medan

Abstract

Background: Liver cirrhosis remains a major global health problem with high in- hospital mortality, especially in Southeast Asia. Prognostic models such as Child–Pugh, MELD, and ALBI have variable accuracy, necessitating simpler and more practical tools. This study aimed to identify independent predictors of in-hospital mortality among cirrhotic patients in Indonesia and to propose a novel prognostic function. Methods: A retrospective cohort study was conducted among 190 cirrhotic patients admitted to Adam Malik General Hospital, Medan, Indonesia, between 2023 and 2024. Demographic, clinical, and laboratory variables were collected. Bivariate and multivariate logistic regression analyses were performed to determine predictors of mortality. A novel prognostic model was derived from significant factors, and its performance was evaluated using AUROC and Hosmer–Lemeshow calibration. Results: Of 190 patients, 79 (41.6%) died during hospitalization. Independent predictors of in-hospital mortality were grade III–IV hepatic encephalopathy (OR 30.12, 95% CI 10.71–84.67, p<0.001), serum creatinine (ln-transformed, OR 3.23, 95% CI 1.80–5.79, p<0.001), and INR (ln-transformed, OR 17.93, 95% CI 3.54–90.83, p<0.001). The final prognostic model demonstrated excellent discrimination (AUROC 0.906) and good calibration (Hosmer–Lemeshow p=0.587). Conclusion: Severe hepatic encephalopathy, renal dysfunction, and coagulopathy were the strongest predictors of in-hospital mortality among cirrhotic patients. The novel prognostic function derived from these factors showed high predictive accuracy and may support risk stratification in clinical practice, particularly in resource-limited settings. Keywords: liver cirrhosis, mortality, prognostic model, hepatic encephalopathy, creatinine, INR