Precipitating Factors and Outcomes of Hepatic Encephalopathy in Patients with Chronic Liver Disease
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Abstract
Background: Hepatic encephalopathy (HE) is a complex neuropsychiatric condition that significantly impacts patients with chronic liver disease (CLD), leading to hospital admissions and contributing to the economic burden on healthcare systems. The condition's pathogenesis involves various precipitating factors, yet its management remains challenging due to the multifaceted nature of its presentation.
Objective: This study aims to identify the precipitating factors of HE in patients with CLD, assess the severity and outcomes of HE, and evaluate the correlation between precipitating factors and the severity and outcomes of HE in patients admitted to PNS Shifa Hospital, Karachi, Pakistan.
Methods: A descriptive cross-sectional study was conducted over six months, from February 2022 to July 2022, at the Department of Medicine, PNS Shifa, Karachi. A total of 78 patients meeting the inclusion criteria were enrolled through convenience sampling. Informed consent was obtained from each participant. The severity of liver disease was assessed using the Child-Pugh Classification, and the presence and grade of HE were determined using the West Haven criteria. Precipitating factors of HE were evaluated, and patients were followed until discharge to assess the length of hospital stay and in-hospital mortality. Data were analyzed using SPSS version 25, focusing on descriptive and inferential statistics.
Results: The mean age of the participants was 48.77 ± 13.37 years, with the duration of CLD averaging 3.19 ± 1.45 years. Hospital stays ranged from 1 to 7 days, with a median of 5.0 days. Child-Pugh classification revealed 35.9% of patients in Class A, 33.3% in Class B, and 30.8% in Class C. HE grades were distributed as follows: Grade I in 48.7%, Grade II in 24.4%, Grade III in 15.4%, and Grade IV in 11.5% of patients. In-hospital mortality was observed in 15.4% of cases. The most common precipitating factors identified were constipation (59.0%), followed by hypoglycemia (52.6%), and recent excessive paracentesis (48.7%).
Conclusion: The study underscores the importance of identifying and managing precipitating factors of HE in patients with CLD to mitigate the severity of HE and improve patient outcomes. Constipation, hypoglycemia, and recent excessive paracentesis were the most prevalent precipitating factors, suggesting targeted interventions in these areas could reduce the incidence and severity of HE.
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References
Kabir MA, Chowdhury J, Bari MA, Bodruddoza K, Saha A, Alam S. Detection of precipitating factors of hepatic encephalopathy in chronic liver disease patients in a tertiary hospital. J Medicine. 2017;19(1):10-4.
Montagnese S, Bajaj JS. Impact of hepatic encephalopathy in cirrhosis on quality-of-life issues. Drugs. 2019;79(Suppl 1):11-6.
Leise MD, Poterucha JJ, Kamath PS, Kim WR. Management of hepatic encephalopathy in the hospital. Mayo Clin Proc. 2014;89(2):241-53.
Stepanova M, Mishra A, Venkatesan C, Younossi ZM. In-hospital mortality and economic burden associated with hepatic encephalopathy in the United States from 2005 to 2009. Clin Gastroenterol Hepatol. 2012;10(9):1034-41.
Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, et al. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the American Association for the study of liver diseases and the European Association for the study of the liver. Hepatology. 2014;60(2):715-35.
Devrajani BR, Shah SZ, Devrajani T, Kumar D. Precipitating factors of hepatic encephalopathy at a tertiary care hospital Jamshoro, Hyderabad. J Pak Med Assoc. 2009;59(10):683-6.
Poudyal NS, Chaudhary S, Sudhamshu KC, Paudel BN, Basnet BK, Mandal A, et al. Precipitating factors and treatment outcomes of hepatic encephalopathy in liver cirrhosis. Cureus. 2019;11(4):e4363.
Mumtaz K, Ahmed US, Abid S, Baig N, Hamid S, Jafri W. Precipitating factors and the outcome of hepatic encephalopathy in liver cirrhosis. J Coll Physicians Surg Pak. 2010;20(8):514-8.
Qazi Arisar FA, Khan SB, Umar A. Hepatic encephalopathy in chronic liver disease: predisposing factors in a developing country. Asian J Med Sci. 2014;6(2):35-42.
Alam I, Razaullah, Haider I, Hamayun M, Taqweem A, Nisar M. Spectrum of precipitating factors of hepatic encephalopathy in liver cirrhosis. Pak J Med Res. 2005;44:96-100.
Bellafante D, Gioia S, Faccioli J, Riggio O, Ridola L, Nardelli S. Old and New Precipitants in Hepatic Encephalopathy: A New Look at a Field in Continuous Evolution. J Clin Med. 2023;12(3):1187. https://doi.org/10.3390/jcm12031187
Ochoa-Sanchez R, Rose CF. Pathogenesis of Hepatic Encephalopathy in Chronic Liver Disease. J Clin Exp Hepatol. 2018 Sep;8(3):262-271. doi: 10.1016/j.jceh.2018.08.001. Epub 2018 Aug 18. PMID: 30302043; PMCID: PMC6175755.
Khobragade H, Manohar T, Sathawane A. Precipitating Factors and Clinico-Endoscopic Study of Patients with Hepatic Encephalopathy Type C. J Contemp Med. 2022 Jul 7;12(4):559-64.
Tariq M, Iqbal S, Khan NU, Basri R. Precipitating factors of hepatic encephalopathy. Rawal Med J. 2009;34:95–7.
Almani SA, Memon AS, Memon AI, Shah I, Rahpoto Q, Solangi R. Cirrhosis of liver: Etiological factors, complications and prognosis. J Liaquat Uni Med Health Sci. 2008;7(2):61-6.
Blei AT, Bircher J, Benhamou JP, McIntyre N, Rizzetto M, Rodés J. Hepatic encephalopathy. In: McIntyre N, Benhamou JP, Bircher J, Rizzetto M, Rodés J, editors. Oxford Textbook of Clinical Hepatology. Oxford: Oxford Medical; 1998. p. 765-83.
Gilberstadt SJ, Gilberstadt H, Zieve L, Buegel B, Collier RO Jr, McClain CJ. Psychomotor performance defects in cirrhotic patients without overt encephalopathy. Arch Intern Med. 1980;140:519-21.
Gitlin N, Lewis DC, Hinkley L. The diagnosis and prevalence of subclinical hepatic encephalopathy in apparently healthy, ambulant, non-shunted patients with cirrhosis. J Hepatol. 1986;3:75-82.
Lockwood AH. Early detection of hepatic encephalopathy. Neurology. 1998;6:663-6.
Chen DS. Public health measures to control hepatitis B virus infection in the developing countries of the Asia-Pacific Region. J Gastroenterol Hepatol. 2000;15:E7-10.