Analysis of Identifiable Risk Factors Precipitating Acute Encephalopathy in Chronic Liver Disease, At PNS Shifa Karachi

Abstract

Background: Hepatic encephalopathy is one of the most debilitating manifestations   and frequent complication in patients suffering from chronic liver disease. Objective: To determine the frequency of identifiable risk factors precipitating hepatic encephalopathy in patients with chronic liver disease, at PNS Shifa Karachi and their correlation with grades of hepatic encephalopathy, length of hospital stay and mortality. Study Design: It was a cross sectional study Period: 24 Oct 2014 to 31 Aug 2015. Methods: during which 96 patients of clinically diagnosed hepatic encephalopathy associated with CLD were enrolled. Hepatic encephalopathy was graded and precipitating factors identified based on history, clinical examination and relevant laboratory investigations. Management was carried out according to the latest guidelines. Patients were followed up till discharge/death from the hospital and duration of hospital stay. Mortality was recorded. Results: Majority of patients (57.3%) had one precipitating factor; more than one factor was found in 43.5%. Gastrointestinal bleed was the most common precipitating factor identified in 42 (44%) patients followed by Infection in 36 patients (38%), diuretic therapy in 10 patients associated with electrolyte imbalance (11%), constipation in 8 (9%) patients, use of high protein diet in 7(6.72%), sedative /tranquilizers in 4(3.84 %) and large volume paracentesis in 4 (3.84%) were least common factors, Mean hospital stay was 11 ± 1.8 days. Mortality was 15 % with 14 patients expiring during the hospital stay. There was no statistically significant correlation between the various precipitating factors and grade of hepatic encephalopathy, length of hospital stay and mortality (p >0.05). Conclusion: Commonest precipitating factors of hepatic encephalopathy in patients of liver cirrhosis are, gastrointestinal bleed, infection, electrolyte imbalance and constipation. There is no correlation between the various precipitating factors and grade of hepatic encephalopathy, length of hospital stay and mortality. There is a need to improve the awareness of patients and attendants about the precipitating factors and their avoidance. This also includes effective control measures against rising cases of hepatitis C and hepatitis B as it is the leading cause of liver cirrhosis in Pakistan.