CHRONIC LIVER DISEASE AND UNEXPECTED DEATH: CLINICAL-FORENSIC ANALYSIS
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Keywords
Chronic liver disease, sudden death, cirrhosis, variceal hemorrhage, forensic autopsy
Abstract
Background: Chronic liver disease is a significant international health issue and is more often linked to acute decompensation and sudden and unexpected death. Most of these deaths do not take place in a hospital environment and would have to be medico-legally investigated to find out how and what actually caused the death. Clinical and autopsy correlations are needed to be understood to make appropriate certification and prevention strategies.
Objective: To analyze the clinical characteristics, terminal events, and autopsy findings in cases of unexpected death among patients with chronic liver disease.
Methodology: This clinical-forensic observational study has sampled 72 cases of deaths due to chronic liver disease that were confirmed through an autopsy procedure that took place from November 2023 to October 2024 at Sir Syed College of Medical Sciences (For Girls) & Khairpur Medical College, Khairpur Mir’s. The demographic information, the clinical history, lab parameters, conditions of death, and post-mortem were noted. Child-Pugh classification was used to measure the severity of the disease and the relationships between the severity and cause of death were evaluated with chi-square test.
Results: Most deaths occurred in males aged 41–60 years, with hepatitis C being the most common etiology. Over half of the patients were in Child-Pugh class C at the time of death. The majority of deaths were unwitnessed and occurred at home. Variceal hemorrhage was the leading cause of death followed by hepatic encephalopathy and sepsis, showing significant association with advanced cirrhosis (p<0.05). Autopsy frequently demonstrated portal hypertension, splenomegaly, and massive gastrointestinal bleeding.
Conclusion: Unexpected deaths in chronic liver disease mainly result from preventable complications of portal hypertension and hepatic failure. Autopsy examination plays a crucial role in distinguishing natural death from suspicious circumstances and highlights the importance of early identification of high-risk patients.
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Vinod Kumar
Assistant Professor of Medicine, Sir Syed College of Medical Sciences (for Girls), Karachi, Pakistan.
Rajesh
Associate Professor of Medicine, Sir Syed College of Medical Sciences (for Girls), Karachi, Pakistan
Hina Rukhsar
Assistant Professor Forensic Medicine & Toxicology Department, Khairpur Medical College, Khairpur Mir's, Pakistan.
Shabeeta Bai
Assistant Professor of Pediatric Nephrology, Sindh Institute of Child Health and Neonatology, Karachi, Pakistan.
