Identification of Precipitating Factors in Hepatic Encephalopathy Patients at Liaquat University Hospital Jamshoro

Hepatic Encephalopathy (HE) is an extra-hepatic complication of liver dysfunction manifested by neuropsychiatric features associated with acute or chronic liver disease, after exclusion of other known brain diseases. There are various factors which can precipitate HE. The purpose of this study was to identify precipitating factors of HE in liver cirrhosis patients at Liaquat University Hospital Jamshoro. It was a hospitalbased descriptive study conducted from 1 January 2009 to 15 August 2009 at Liaquat University Hospital st th Jamshoro, Sind, Pakistan. During this study, 100 admitted patients manifesting symptoms and signs of HE associated with liver cirrhosis were enrolled. All patients were more than 12 years old and diagnosed as HE on history, comprehensive clinical examination and relevant laboratory investigations. The data has been collected on preformed proforma .The grades of HE and Child’s Pugh Classification have also been noted in order to assess prognosis. Most 77(77%) patients were older than 40 years including 57(74%) males and 20(26%) females with M to F ratio of 2.85:1 in this group. Majority of patients 70(70%) were from rural areas of Sindh having poor socio-economic status. A large number of patients 72(72%) were in grade IV followed by 18(18%) in grade III encephalopathy. AntiHCV has been found positive in 72(72%) of our patients. The most common precipitating factors of HE detected in our study were infections 53 (53%), GI bleeding 51(51%), constipation 49 (49%) and high protein diet 47(47%). Usage of coughsyrups, largevolume paracentesis, sedative and tranquilizer drugs were least common factors. 72(72%) of our patients have associated ascites, 12(12%) spontaneous bacterial peritonitis and 6 (6%) hepatorenal syndrome. Laboratory analysis revealed low hemoglobin in 61(61%), thrombocytopenia in 53(53%), leukocytosis in 73(73%), hypo-albuminemia in 52(52%), hypokalemia in 31(31%), hyponatremia in 27 (27%) and abnormal coagulation profile in 51(51%) of our cases. 65(65%) patients recovered completely and were discharged from the hospital, while 25(25%) expired. All expired patients were in Class C of Child’s Pugh Classification. The overall in-hospital mortality was 25% in our study. This study concludes that infection, GI bleeding, constipation and high protein diet were the most common precipitating factors of HE in our patients. So there is a definite need of health education and proper counseling to liver cirrhosis patients.