Serial assessment of hepatic encephalopathy in patients hospitalised for acute decompensation of cirrhosis (original) (raw)
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Prognostic significance of hepatic encephalopathy in patients with cirrhosis
Journal of Hepatology, 1999
There are numerous studies concerning the natural history and prognostic factors in cirrhosis, the results of which are useful in selecting liver transplant candidates. However, little attention has been paid to the prognostic significance of hepatic encephalopathy despite the high frequency of this complication. Methods: We reviewed the charts of Ill cirrhotic patients who developed a first episode of acute hepatic encephalopathy to determine their survival probability and to identify prognostic factors. Results: During follow-up (12st17 months), 82 (74%) patients died. The survival probability was 42% at 1 year of follow-up and 23% at 3 years. With univariate analyses followed by a multivariate analysis, 7 out of 30 clinical and standard laboratory variables were significantly associated with poor prognosis: male sex, increased serum bilirubin, alkaline phosphatase, potassium and blood urea nitrogen, and decreased serum
Hepatic Encephalopathy in Liver Cirrhosis: Precipitating factor and Outcome
Journal of Nepalgunj Medical College, 2019
Introduction: Hepatic encephalopathy, one of the major decompensating events of liver cirrhosis manifest as a wide spectrum of neurological or psychiatric abnormalities ranging from subclinical alterations to coma. The main aim of this study was to determine precipitants of hepatic encephalopathy (HE) and their impact on hospital stay and mortality. Methods: A hospital based cross-sectional study carried out in the Department of Medicine, Nepalgunj Medical College, Kohalpur from September 2018 to May 2019. Patients of liver cirrhosis with signs and symptoms of hepatic encephalopathy (HE) were enrolled in the study. Detailed history was taken with patients or patient's visitor regarding precipitating factors. Child Turcotte Pugh (CTP) class was used for assessing liver disease severity and West Haven classification was used for grading of hepatic encephalopathy. Results: Total patients of hepatic encephalopathy studied were 150. Among which, 114 (76%) were male and 36 (24%) were ...
Hepatology Research, 2013
Aim: Minimal hepatic encephalopathy (MHE) affects more than 30% of patients with cirrhosis, and it has been suggested that despite no recognizable clinical symptoms of neurological abnormalities, it may affect health-related quality of life (HRQL); however, this fact remains controversial. The aim of our study was to evaluate the prevalence of MHE and HRQL in patients diagnosed with decompensated cirrhosis.
A New Look at Precipitants of Overt Hepatic Encephalopathy in Cirrhosis
Digestive diseases and sciences, 2017
Overt hepatic encephalopathy (HE) is a major cause of significant morbidity and mortality in patients with liver cirrhosis. We examined the frequency and profile of the precipitating factors resulting in hospitalizations for overt HE. We conducted both retrospective and prospective studies to identify clinical precipitants of overt HE in patients with cirrhosis. The retrospective study patients were hospitalized at a large urban safety-net hospital, and the prospective study included the patients admitted at a liver transplant center. There were a total of 149 patients with cirrhosis and overt HE (91 males, mean age 55.3 ± 8.6 years) in the retrospective group and 45 patients (27 males, mean age 58.3 ± 8.2 years) in the prospective group of the study. The average MELD score was 16 ± 6.8 in the retrospective group and 22.7 ± 7.2 in the prospective group. Dehydration (46-76%), acute kidney injury (32-76%), lactulose nonadherence (about 50%), constipation (about 40%), and infections (2...
Clinical Spectrum of Precipitating Factors of Hepatic Encephalopathy in Patient of Liver Cirrhosis
Objective: To determine the precipitating factors of hepaticencephalopathy (HE) in patients with liver cirrhosis Background and Objectives: Hepatic encephalopathy is an extra hepatic complication of impairedliver function and is manifested as neuropsychiatric signs and symptoms associated with acute or chronic liver disease in the absence of other neurological disorders. This study aims to ascertain the spectrum of precipitating factors of hepatic encephalopathy in patients with cirrhosis of liver.
Predicting in-hospital mortality of cirrhotic patients hospitalized with hepatic encephalopathy
Egyptian Liver Journal, 2022
Background Hepatic encephalopathy (HE) is a serious condition associated with high rates of mortality. Many scoring systems are used to predict the outcome of HE in patients admitted to the intensive care unit (ICU). The most used scores are Child-Turcotte-Pugh (CTP), Model for End-stage Liver Disease (MELD), Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA), and Acute Physiology and Chronic Health Evaluation II (APACHE II). These scores were thoroughly investigated in HE associated with acute liver failure (type A). In the present study, we aimed to evaluate the prognostic value of these scores in patients with HE on a background of liver cirrhosis (type C). Two hundred cirrhotic patients hospitalized with HE were included in the study. Diagnosis and classification of HE were based on the West Haven criteria. APACHE II, CLIF-SOFA, MELD, MELD-Na, and CTP scores were calculated for all patients within the first 24 h after admission. According to survival outcomes,...
Precipitating Factors and Treatment Outcomes of Hepatic Encephalopathy in Liver Cirrhosis
Cureus, 2019
Background Hepatic encephalopathy (HE) is a common cause of hospital admission in patients with liver cirrhosis (LC). The aims of this study were to evaluate the precipitant factors and analyze the treatment outcomes of HE in LC. Methods All the LC patients admitted between February 2017 and January 2018 for overt HE were analyzed for precipitating factors and treatment outcomes. Treatments were compared among three treatment groups: receiving lactulose, lactulose plus L-ornithine L-aspartate (LOLA), and lactulose plus rifaximin. The primary endpoints were mortality and hospital stay. The chisquare test was used to compare the different treatment outcomes with hospital stay and mortality with significance at p<0.05.
A Model For Predicting Development of Overt Hepatic Encephalopathy in Patients With Cirrhosis
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2015
Overt hepatic encephalopathy (HE) affects patients' quantity and quality of life and places a burden on families. There is evidence that overt HE might be prevented pharmacologically, but prophylaxis would be justified and cost-effective only for patients at risk. We aimed to identify patients with cirrhosis at risk for overt HE. We collected data from October 2009 through December 2012 on 216 consecutive patients with cirrhosis (based on liver biopsy, 96 patients with minimal HE), admitted into the Gastroenterology Unit at the University of Rome. Patients were followed and evaluated for an average of 14.7±11.6 months; development of overt HE was recorded. We analyzed end-stage liver disease scores, shunt placement, previous overt or minimal HE, psychometric hepatic encephalopathy score (PHES), and levels of albumin, bilirubin, creatinine, and sodium to develop a prediction model. We validated the model in 112 patients with cirrhosis seen at the University of Padua and followed ...
Hepatic encephalopathy in liver cirrhosis
Journal of Translational Internal Medicine
Liver cirrhosis is a worldwide gastroenterological condition, characterized by a slow, progressive and irreversible replacement of liver cells by fibrous tissue (scar) that prevents liver function. This condition often leads to the development of other syndromes. Cardiac complications can be indicated through abnormal QTc interval and arrhythmias, thereby their analysis aids in the prevention of cardiovascular events. Most cirrhotic cases have abnormal laboratory values (bilirubin, albumin, AST, ALT, AST/ALT, INR) indicating the presence of concomitant infection, inflammation and coagulopathy. In this case report, the usage Halstead-Reitan and Child-Pugh score helped in the assessment of the status of deterioration of brain. The knowledge of liver cirrhosis aetiologies help to determine the predisposition to development of hepatic encephalopathy and cardiomyopathy. The different values of liver enzymes and other blood laboratory analyses indicated the level of liver damage and poor ...
Clinical Spectrum of Precipitating Factors of Hepatic Encephalopathy in Cirrhosis of the Liver
IOSR Journals , 2019
Background and Objectives: Hepatic encephalopathy is an extra hepatic complication of impaired liver function and is manifested as neuropsychiatric signs and symptoms associated with acute or chronic liver disease in the absence of other neurological disorders. This study aims to ascertain the spectrum of precipitating factors of hepatic encephalopathy in patients with cirrhosis of the liver. Methods: 100 cases of cirrhosis of the liver who presented in hepatic encephalopathy admitted to Sri Venkateswara Ramnarain Ruia Government General Hospital(SVRRGGH) ,Tirupati between may 2017 and april 2018 were studied. All patients of more than 18 years of age, manifesting with signs of hepatic encephalopathy were included, and those who had acute fulminant hepatitis or non cirrhotic portal hypertension were excluded from the study. Detailed history, clinical examination and thorough investigations were done to look for any precipitating factor and the findings were recorded on a proforma and prognostic stratification through Child-Pugh score was done. Results: Out of 100 patients, Upper GI bleed (51%), Constipation (41%), Electrolyte imbalance (38%) and Infection (22%) stood out as the most common precipitating factors. Usage of diuretics, sedatives, and excess dietary protein were the other factors. Most patients were in grade III (30%) and grade IV (37%) of hepatic encephalopathy. Other common associations were Child Pugh class C (67%), mortality (37%), and Alcoholism (54%). Interpretation and Conclusion: Upper GI bleed, Constipation, Infection, and Electrolyte imbalance were the most common precipitating factors of Hepatic encephalopathy in this study.