Background Liver failure is a debilitating disease and a major cause of morbidity and mortality. It has a wide spectrum of aetiological factors that lead to different clinical outcomes. Data on the clinical outcomes of liver failure in low income settings are scanty. We set out to evaluate the clinical outcomes and predictors of mortality in liver failure at the main referral and teaching hospital in Zambia.

Methods We consecutively enrolled patients with liver failure at the University Teaching Hospital, Lusaka, Zambia from May 2020 to May 2021. This was an observational cohort study and patients were prospectively followed up for 30 days or until death. Demographics, clinical findings and laboratory investigations were recorded and summary statistics were used to describe data. Predictors of mortality were determined by Cox regression.

Results Out of 59 adult patients whom we evaluated, we enrolled 51 patients who fulfilled the inclusion criteria. The mean age was 43±14 years with 39 (77%) being males. The majority had liver failure whose cause was unknown (27; 53%). Hepatitis B virus was positive in 9 (18%) patients, hepatitis A antibodies were positive in 4 (8%) patients while the antibodies to hepatitis C were positive in 2 (4%) patients. Antituberculosis therapy was suspected to cause liver failure in 9 (18%) patients. Predictors of mortality were low albumin (HR 0.909 [95% CI 0.849-0.973], P=0.006), low neutrophils (HR 0.9928 [95% CI 0.866-0.995], p=0.036), low Karnofsky performance status score (HR 0.417 [95% CI 0.290-0.599], P<0.001), low platelet count (HR 1.002 [95% CI 1.0004-1.00041], P=0.015) and cirrhosis (HR 0.453 [95% CI 0.209-0.979], P=0.044). Mortality rate was 69% (35/51).

Conclusion Patients with liver failure had high mortality rate within the 30-day follow-up. Low albumin, neutrophil count, platelet count and low Karnofsky performance status score including cirrhosis predicted mortality.

The authors have declared no competing interest.

The author(s) received no specific funding for this work.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

IRB: Universit of Zambia Biomedical Research Ethics Committee (UNZABREC) Approval number: REF: 660-2019 The approval was base on the following documents that were submitted for review a) Study proposal b) Questionnaires c) Participant Consent Form Form of consent: Written Date of approval: May 22nd, 2020

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