Clinical profile, Precipitating factors and outcomes in patients with Hepatic Encephalopathy with chronic liver disease in referral center

Background and Aim: The liver disease is serious health problem India. Hepatic encephalopathy (HE) is common complication of cirrhosis. There is paucity of data on clinical profile, precipitating factors, and prognosis of HE in India. We aimed to study the clinical profile, precipitating factors, and outcomes in patients with hepatic encephalopathy with chronic liver disease. Methods: 100 patients admitted in referral hospital with overt HE was enrolled in this study. All patients were followed up for one year after enrolment. Results: The mean age of patients was 46.22 ±10.97 (18 to 78 years) with male to female ratio of 8: 2. Most of the patients had child C cirrhosis (78) with a mean CTP score of 11.31±2.09 and MELD score of 23.67±8.42. Most of the patients had HE grade II (62) followed by III (32) and IV (6). Alcohol was the most common cause of cirrhosis (53). Most common precipitant factors for HE was diuretic use (59), active alcoholism (44), azotemia (43), hyponatremia (43), constipation (38), sepsis (28), and GI bleeding (27). 73 patients had reversal of HE at Day 5. In-hospital mortality was 21%. Patients with child C cirrhosis and HE grade IV had higher mortality of 25.64% and 83.33% respectively. The mean ammonia level was 130.29±48.25 μmol/L, which correlates well with the severity of HE. On univariate analysis, ammonia, WBC, Neutrophil, INR, urea, creatinine, bilirubin, SGOT, MELD and CTP score differs significantly between survivors and non survivors (P<0.05). On multivariate analysis only raised serum bilirubin was independently associated with mortality (P value<0.036, OR: 1.126, 95% CI :1.007-1.258).60.76% patients had recurrent episode of HE within one year. Conclusion: Development of HE is associated with worse outcome with mortality of 21%. Serum bilirubin was independently associated with increased mortality in patients with HE and Cirrhosis.