Prevalence of Hepatic Encephalopathy and Its Precipitating Factors in CLD Cirrhotic Patients

Abstract

Objectives of Study: Hepatic Encephalopathy is a spectrum of neuropsychiatric abnormalities in patients with acute or chronic liver dysfunction, after exclusion of brain disease. It is characterized with intellectual impairment, personality changes, and a depressed state of consciousness. This study is underwent to study the clinical profile, important precipitating factors and outcome of hepatic encephalopathy in hospitalized CLD patients. Methods: Cross-sectional, observational descriptive study which was undergone at Chaudhry Hospital, Gut and Liver Center, Gujranwala, Pakistan, on a sample size of 145 hospitalized CLD patients, out of which 92 with Hepatic Encephalopathy during August 2016 to December 2016. Data was analyzed by SPSS v22.0 and the results are expressed as counts and percentage. Results: Prevalence of hepatic encephalopathy in CLD patients is 63.4% with average age of patients above 40 years and 60% male predominance. The main precipitating factor for hepatic encephalopathy is underlying infection 57% (n=52) and upper gastrointestinal bleed 29% (n=27). The most common comorbidity is diabetes mellitus i.e. 62% (n=57). The main cause for CLD is hepatitis B and C related liver cirrhosis in our study. Among 92 patients, 42% (n=39) presented in grade 2 hepatic encephalopathy followed by 30% (n=27), 19.5% (n=18) and 8.5% (n=8) in grade 3, 1 and 4 respectively. Among 92 patients, 73% (n=67) got discharged after a stay of 5 ±2 days and 27% (n=25) expired. Among 25 expired patients, 71% (n=17) with Child-Pugh Score class C. Conclusion: The prevalence of HE is more than 60% and main precipitating factor for hepatic encephalopathy is underlying infection. Diabetes mellitus is important co-morbidity factor observed in more than half of the patients. Majority of the patients present in grade 1 have good outcome. Expiry rate is higher in patients presenting with grade 3 and 4 hepatic encephalopathy and with Child-Pugh Score of class C.