Precipitating Factors and Outcomes of Hepatic Encephalopathy in Patients with Chronic Liver Disease

Main Article Content

Sana Akhtar
Zainab Fakhar
Samina Khan
Abdul Razzaque Nohri
Sultan Ahmed Nohario
Muhammad Ali Memon


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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How to Cite
Akhtar, S., Fakhar, Z., Khan, S., Nohri, A. R., Nohario, S. A., & Memon, M. A. (2024). Precipitating Factors and Outcomes of Hepatic Encephalopathy in Patients with Chronic Liver Disease. Journal of Health and Rehabilitation Research, 4(1), 701–705.
Author Biographies

Sana Akhtar, Sindh Institute of Urology & Transplantation Pakistan.

Post-Fellow Resident.

Zainab Fakhar, Bahria University of Health Sciences Karachi Pakistan.

Senior Registrar.

Samina Khan, PNS Shifa Hospital Karachi Pakistan.

Postgraduate Trainee.

Abdul Razzaque Nohri, Health Department Government of Sindh

Senior Pharmacist.

MSPH Candidate Liaquat University of Medical Health Sciences Jamshoro

Sultan Ahmed Nohario, Liaquat University of Medical and Health Science Jamshoro

Physician General

Muhammad Ali Memon, Liaquat University of Medical and Health Science Jamshoro

Physician General


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