Liver Cirrhosis of Unknown Etiology and Its Predictors in Eastern Ethiopia

Figures & data

Table 1 Sociodemographic Characteristics of Liver Cirrhosis Patients in Eastern Ethiopia, 2020/21

Characteristics	Categories	Etiology
		Unknown 98 (%)	Known 29 (%)
Gender	Male	63 (64)	21 (72)
	Female	35 (36)	8 (28)
Age	Median (IQR)	32 (27–46)	35 (30–47)
	<35 years	51 (52)	14 (48)
	35–44 years	19 (20)	4 (14)
	45–54 years	13 (13)	5 (17)
	> 55 years	15 (15)	6 (21)
Residence	Urban	14 (14)	6 (21)
	Rural	84 (86)	23 (79)
Formal education	No	78 (80)	24 (83)
	Yes	20 (20)	5 (17)
Occupation	Farmer	81 (82.7)	23 (79.3)
	Housewife	6 (6.1)	1 (3.4)
	Student	5 (5.1)	1 (3.4)
	Public servant	1 (1)	3 (10.3)
	Other^a	5 (2)	1 (0)

Notes: N= 127; n for unknown =98; n for known =29; ^aIncludes unemployed, daily laborer, and merchant.

Abbreviation: IQR, inter quartile range.

Table 2 Lifestyle, Dietary and Other Characteristics of Liver Cirrhosis Patients in Eastern Ethiopia, 2020/21

Characteristics	Categories	Etiology
		Unknown 98 (%)	Known 29 (%)
Family history of liver disease*	No	90 (92)	21 (72)
	Yes	8 (8)	8 (28)
Body mass index (BMI)	Normal	59 (60)	14 (48)
	Underweight	34 (35)	11 (38)
	Overweight	5 (5)	4 (14)
Herbal medicine use	No	89 (91)	26 (90)
	Yes	9 (9)	3 (10)
Khat use	No	38 (39)	10 (34)
	Yes	60 (61)	19 (66)
Tobacco use	No	78 (80)	21 (72)
	Yes	20 (20)	8 (28)
History of alcohol use	No	98 (100)	27 (93)
	Yes	0 (0)	2 (7)
Alcohol abuse	No	98 (100)	28 (97)
	Yes	0 (0)	1 (3)
Staple food*	Rice/Teff/Corn	14 (14)	11 (38)
	Sorghum	84 (86)	18 (62)
Source of staple food	Market	41 (42)	18 (62)
	Home	57 (58)	11 (38)
Staple food stored underground^a	No	28 (49)	7 (64)
	Yes	29 (51)	4 (36)
Peanut intake	No intake	48 (49)	15 (52)
	Intermittent intake^b	11 (11)	2 (7)
	Frequent intake^c	39 (40)	12 (41)

Notes: N= 127; n for unknown =98; n for known =29; *p < 0.05 (from chi-square or Fisher exact test); ^a when the source is from home ^b 0.25 to 4 times per week; ^cAt least once per day.

Table 3 Clinical and Ultrasound Features of Liver Cirrhosis Patients in Eastern Ethiopia, 2020/21

Characteristics	Categories	Etiology
		Unknown 98 (%)	Known 29 (%)
Clinical features
Jaundice	No	28 (29)	10 (34.5)
	Yes	70 (71)	19 (65.5)
Weight loss	No	24 (24.5)	10 (34.5)
	Yes	74 (75.5)	19 (65.5)
Epigastric pain	No	31 (42)	9 (31)
	Yes	57 (58)	20 (69)
Abdominal distension	No	3 (3)	1 (3)
	Yes	95 (97)	28 (97)
Fever	No	70 (71)	21 (72)
	Yes	28 (29)	8 (28)
Hematemesis	No	55 (76.5)	21 (72)
	Yes	23 (23.5)	8 (28)
Anorexia	No	18 (18)	3 (10)
	Yes	80 (82)	26 (90)
Splenomegaly*	No	9 (9)	8 (28)
	Yes	89 (91)	21 (72)
Ultrasound features
Liver surface	Smooth	4 (4)	4 (14)
	Mild uneven surface	28 (29)	7 (24)
	Undulant surface	66 (67)	18 (62)
Liver parenchyma	Homogenous	2 (2)	0 (0)
	Heterogenous	85 (87)	25 (86)
	Coarse	11 (11)	4 (14)
Hepatic vessel	Smooth	62 (63)	17 (59)
	Obscured or blurred	28 (29)	9 (31)
	Irregular & narrowed	8 (8)	3 (10)
Spleen size index*	<20 cm^2	9 (9)	8 (28)
	>20 cm^2	89 (91)	21 (72)
Ascites	No	3 (3)	2 (7)
	Yes	95 (97)	27 (93)

Notes: N= 127; n for unknown =98; n for known =29; *p value < 0.05 from the chi-square or Fisher exact test.

Table 4 Laboratory Findings of Liver Cirrhosis Patients in Eastern Ethiopia, 2020/21

Laboratory Findings	Categories	Etiology
		Unknown 98 (%)	Known 29 (%)
ALT (U/L)	Median (IQR)	40 (20–52)	48 (20–60)
	Normal	49 (50)	14 (48)
	Abnormal	49 (50)	15 (52)
AST (U/L)	Median (IQR)	48 (31–73)	58 (30–101)
	Normal	38 (39)	9 (31)
	Abnormal	60 (61)	20 (69)
ALP (U/L)	Median (IQR)	142 (89–243)	164 (95–265)
	Normal	56 (57)	15 (52)
	Abnormal	42 (43)	14 (48)
Bilirubin, direct (µmol/L)	Median (IQR)	9 (3–15)	10 (4–18)
	Normal	49 (50)	13 (45)
	Abnormal	49 (50)	16 (55)
Bilirubin, total (µmol/L)	Median (IQR)	18 (7–32)	16 (8–34)
	Normal	80 (82)	23 (79)
	Abnormal	18 (18)	6 (21)
Albumin (g/L)	Median (IQR)	31 (23–39)	27 (24–32)
	Normal	33 (34)	5 (17)
	Abnormal	65 (66)	24 (83)
Creatinine (μmol/L)	Median (IQR)	64 (48–82)	77 (49–96)
	Normal	94 (96)	25 (86)
	Abnormal	4 (4)	4 (14)
Platelet count (10^9/L)	Median (IQR)	185 (123–241)	192 (121–254)
	Normal	68 (69)	21 (72)
	Abnormal	30 (31)	8 (28)
APRI score^a	< 0.7	43 (44)	10 (34.5)
	> 0.7	55 (56)	19 (65.5)
FIB-4 score^b	< 3.25	69 (81)	21 (72)
	> 3.25	19 (19)	8 (28)
HBV positive	No	98 (100)	2 (7)
	Yes	0 (0)	27 (93)
HCV positive	No	98 (100)	28 (97)
	Yes	0 (0)	1 (3)

Notes: N= 127; n for unknown= 98; n for known= 29. ALT (8–40 U/L), AST (14–40 U/L), ALP (48–164 U/L), Bilirubin direct (0.4–8.8 μmol/L), Bilirubin total (3–38 μmol/L), Albumin (35–52 g/L), Creatinine (47–109 μmol/L), Platelet count (126–438 × 109/L). ^a APRI= (AST (U/L)/ULN of AST (U/L))/platelet count (109/L) × 100; ^b FIB-4= age (years) x AST (U/L)/ (platelet count (109/L) x √ALT (U/L)).

Abbreviations: ALP, Alkaline Phosphatase; ALT, Alanine Aminotransferase; APRI, Aspartate Aminotransferase to Platelets Ratio Index; AST, Aspartate Aminotransferase; FIB-4, Fibrosis Index Based on 4 Factors; HBV, hepatitis B Virus; HCV, hepatitis C Virus; IQR, inter quartile range.

Table 5 Predictors of Unknown Etiology of Liver Cirrhosis in Eastern Ethiopia, 2020/21

Variables	Categories	Etiology		COR (95% CI)	AOR (95% CI)
		Unknown 98 (%)	Known 29 (%)
Gender	Male	63 (64)	21 (72)	0.69 (0.28, 1.71)	0.72 (0.23, 2.22)
	Female	35 (36)	8 (28)	1.00	1.00
Age	<35 years	51 (52)	14 (48)	1.00	1.00
	35–44 years	19 (20)	4 (14)	1.30 (0.38, 4.46)	1.75 (0.40, 7.60)
	45–54 years	13 (13)	5 (17)	0.71 (0.22, 2.34)	0.77 (0.19, 3.17)
	> 55 years	15 (15)	6 (21)	0.69 (0.23, 2.10)	0.67 (0.17, 2.72)
Family history of liver disease	No	90 (92)	21 (72)	1.00	1.00
	Yes	8 (8)	8 (28)	0.23 (0.08, 0.69)	0.24 (0.06, 0.91)*
Body mass Index	Normal	59 (60)	14 (48)	1.00	1.00
	Underweight	34 (35)	11 (38)	0.7 (0.3, 1.8)	0.55 (0.19, 1.59)
	Overweight	5 (5)	4 (14)	0.3 (0.07, 1.3)	0.49 (0.09, 2.83)
Staple food	Rice/Teff/Corn	14 (14)	11 (38)	1.00	1.00
	Sorghum	84 (86)	18 (62)	7.5 (2.2, 25.5)	3.8 (1.2, 12.5)*
Splenomegaly	No	9 (9)	8 (28)	1.00	1.00
	Yes	89 (91)	21 (72)	0.3 (0.09, 0.77)	4.0 (1.1, 14.4)*
Serum albumin	Normal	33 (34)	5 (17)	1.00	1.00
	Abnormal	65 (66)	24 (83)	2.4 (0.85, 6.97)	0.58 (0.18, 1.84)
Serum creatinine	Normal	94 (96)	25 (86)	1.00	1.00
	Abnormal	4 (4)	4 (4)	3.8 (0.88, 16.1)	0.22 (0.04, 1.21)

Notes: N= 127; n for unknown =98; n for known =29; *p < 0.05.

Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; COR, crude odds ratio.