Clinical Profile, Precipitating Factors and Outcome of Hepatic Encephalopathy in Patients with Liver Cirrhosis

Med Phoenix ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 23-27
Author(s):  
Subash Bhattarai ◽  
Dipesh Karki
Keyword(s):  
Hepatic Encephalopathy ◽  
Clinical Profile ◽  
Decompensated Cirrhosis ◽  
Precipitating Factors ◽  
Early Management ◽  
Child Class ◽  
Grade Ii ◽  
Cirrhotic Patients ◽  
Class C ◽  
Upper Gastrointestinal

Introduction: Hepatic encephalopathy (HE) is characterized by reversible neuropsychological features and is observed with advanced and decompensated cirrhosis of the liver. Patients outcomes and survival depends on clinical presentation, identification of the precipitating factor, early management, and treatment of complications. This study aims to find out the clinical profile of cirrhotic patients with hepatic encephalopathy, their precipitating factors, and clinical outcomes in patients admitted at a tertiary care Teaching Hospital in Gandaki province, Nepal. Materials and Methods: An observational, cross-sectional, hospital-based prospective study comprising of 140 cirrhotic patients with encephalopathy was conducted over a study period of 18 months. Their clinical profile, precipitating factors, and outcomes during hospitalization including mortality were studied. The data analysis was done using SPSS version 20 and a P-value of ≤0.05 was considered significant. Results: Majority (36.5%) of the patients presented with Grade II HE. Upper gastrointestinal (GI) bleeding and spontaneous bacterial peritonitis were the most common precipitating factors. Inpatient mortality was 22.9%. The increased mortality rate was observed in patients with Child class C and with higher grading (Grade III and IV) of hepatic encephalopathy and in presence of more than two precipitating factors Conclusion: Most of the patients presented with Grade II HE. Upper gastrointestinal bleed and infections were the most common precipitating factors. Patients with Hepatic encephalopathy of Grades III and IV, those with CTP Child class C, and in presence of more than two precipitating factors have high mortality.

scholarly journals Spectrum of hepatic encephalopathy admitted in a tertiary care center

2020 ◽  
Vol 72 ◽  
pp. 206-210
Author(s):  
Amit Soni ◽  
Shavi Nagpal ◽  
Amit Mittal
Keyword(s):  
Hepatic Encephalopathy ◽  
Hospital Mortality ◽  
Care Center ◽  
Tertiary Care ◽  
Abdominal Distension ◽  
Meld Score ◽  
Tertiary Care Center ◽  
Precipitating Factors ◽  
Cirrhotic Patients ◽  
Class C

Objectives: Few of the common symptoms for which cirrhotic patient seeks medical care are gastrointestinal bleed, abdominal distension (ascites), altered sensorium (hepatic encephalopathy [HE]), etc. This study was done to look at the spectrum of HE among cirrhotic patients admitted in a tertiary care center. Material and Methods: This hospital-based study was carried on 36 HE patients (with liver cirrhosis and age >18 years) admitted in the department of gastroenterology of a tertiary care center, between April 2019 and November 2019. Results: Constipation and infections were the two most frequent precipitating factors identified. Majority patients (77.8%) belonged to CTP Class C. In-hospital mortality was observed in seven patients. The OR was significant for infections and in-hospital mortality (OR – 28.80 and P < 0.05). A moderate positive correlation (Pearson’s correlation, r = 0.335) was seen between MELD score and in-hospital mortality among HE patients. Conclusion: A larger mass of HE patients belongs to CTP Class C. Constipation and infections are the two most common precipitating factors for HE. All HE patients who have concomitant infection and/or high MELD score should be managed on priority basis.

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

2017 ◽  
Vol 10 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Anam Khalid ◽  
Amna Afsar ◽  
Mohammad Arshad ◽  
Ammarah Ghafoor ◽  
Sadaf Khalid ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Precipitating Factors ◽  
Cirrhotic Patients

scholarly journals HEPATIC ENCEPHALOPATHY

2018 ◽  
Vol 25 (12) ◽  
pp. 1857-1862
Author(s):  
Ashok Kumar Lohano ◽  
Shamsuddin Shaikh ◽  
Nazia Arain
Keyword(s):  
Liver Cirrhosis ◽  
Hepatic Encephalopathy ◽  
Serum Sodium Level ◽  
Cross Sectional Study ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Cross Sectional ◽  
Medicine Department ◽  
Grade Ii ◽  
Cirrhotic Patients

Objectives: To determine the prevalence and relation to severity of hyponatremia in liver cirrhotic patients associated with hepatic encephalopathy. Study Design: Cross sectional study. Place and Duration of Study: Medicine Department of Peoples University of Medical and Health Sciences Nawabshah from 26th October 2016 to 25th April 2017. Material and Methods: All patients of either gender with 15 to 70 years associated liver cirrhosis, were included in the study. Diagnosis of liver cirrhosis was confirmed by laboratory and ultrasonographic findings. Exclusion criteria were patients outside of patient range, patients with hepatocellular carcinoma, or anotherco morbid. Sodium levels were measured by 2cc bloodsample by blood from cubital vein preferably. Encephalopathy was evaluated via West Haven classification. All the data were entered into SPSS 20 version and were analyzed by using the same software. Results: A total of 369 patients met the inclusion criteria. Among them were 129 males and 240 females. The overall mean age of study subjects was 57.07±9.23 years. The overall mean duration of hepatic encephalopathy was 2.53±0.733 days. The overall mean serum sodium level for study subjects was 129.59±7.11 mEq/L. Most of the study subjects, 83.5% had HCV, 12.7% patients were HBV positive whereas 3% were positive for HBV as well as HCV. 26 patients had grade 1 encephalopathy, 30 patients had grade II encephalopathies, 258 patients had grade III encephalopathies, and 55 patients had grade IV encephalopathy. In our study, 73.2% study subjects were observed with hyponatremia. Out of 270 study subjects found with hyponatremia, 25.2% had mild hyponatremia, 44.8% had moderate hyponatremia, and 30% had severe hyponatremia. The results showed that there was a significant association of hyponatremia with viral markers (p=0.030), duration of hepatic encephalopathy (p=0.102) and grades of hepatic encephalopathy (p=0.746). Conclusion: We concluded hyponatremia is frequently found in patients with cirrhosis liver. Significant correlation of hyponatremia with the severity of hepatic encephalopathy.

THE STUDY ON PRECIPITATING FACTORS OF HEPATIC ENCEPHALOPATHY IN CIRRHOTIC PATIENT IN WEST BENGAL

2021 ◽  
pp. 28-30
Author(s):  
Partha Pratim Dey ◽  
Debarshi Jana
Keyword(s):  
Hepatic Encephalopathy ◽  
Cirrhotic Patient ◽  
West Bengal ◽  
General Medicine ◽  
Electrolyte Imbalance ◽  
Precipitating Factors ◽  
Medical College ◽  
Cirrhotic Patients ◽  
One Year ◽  
Time Of Presentation

Introduction: Hepatic encephalopathy is a frequent complication and one of the most debilitating manifestations of liver diseases, severely affecting the lives of patients. Aims and objective: i. To study the precipitating factors of hepatic encephalopathy. ii. To observe the clinical manifestation at the time of presentation of hepatic encephalopathy. iii. To observe the seasonal variation of hepatic encephalopathy in cirrhotic patient. Materials and method: General Medicine, Murshidabad Medical college and R. G. Kar Medical college in West Bengal. All adult cirrhotic Patients admitted with encephalopathy in the medicine ward within the study period. One year starting from 1st Nov 2019 to 31st October 2020. Conclusion: This study found that most common precipitating factors of hepatic encephalopathy in our patients are infection, constipation electrolyte imbalance and Variceal Haemorrhage bleeding. These are potentially preventable and reversible.

scholarly journals Duration of the acute hepatic encephalopathy episode determines survival in cirrhotic patients

2017 ◽  
Vol 11 ◽  
pp. 1756283X1774341 ◽  
Author(s):  
Meritxell Ventura-Cots ◽  
Isabel Carmona ◽  
Carolina Moreno ◽  
Javier Ampuero ◽  
Macarena Simón-Talero ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Upper Gastrointestinal Bleeding ◽  
Survival Rates ◽  
Free Survival ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
Acute Hepatic Encephalopathy ◽  
End Stage ◽  
Upper Gastrointestinal ◽  
Time Point

Background: Episodes of hepatic encephalopathy (HE) have been related to low survival rate. However, the relation between its clinical evolution and mortality has not been assessed. Methods: A retrospective analysis of 245 cirrhotic patients admitted for an acute episode of HE (⩾grade 2) or who developed an HE episode after an upper gastrointestinal bleeding (UGIB) event was performed to assess the relation between time in HE and transplant-free survival. Results: Median (IQR25–75) time in HE was 48 h (24–96 h) in the whole cohort. Patients who presented a longer time in HE (>48 h; n = 89) exhibited a lower transplant-free survival at 28 days (67.2% versus 88.9%, p < 0.001), 90 days (48.7% versus 73.8%, p < 0.001) and 365 days (30.3% versus 53.2%, p < 0.001), as compared to those with less time in HE (⩽48 h; n = 156). Survival rates remained significantly different, with lower percentages in the group with time in HE >48 h, when comparing patients according to baseline HE grade (2 versus ⩾3) or model for end-stage liver disease (MELD) function (⩽15 versus >15). Time in HE was also an independent risk factor for mortality at each time point, hazard ratio (HR) (95 CI%) 28 days 2.59 (1.39–4.84); 90 days 1.98 (1.28–3.1) and 365 days 1.5 (1.08–2.19). Conclusions: The duration of the acute HE episode determines survival in cirrhotic patients independently of liver function and baseline HE grade.

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