Abstract
Background: Hepatic Encephalopathy (HE), a common complication of cirrhosis, is associated with a pejorative prognosis. This study aims to describe the clinical presentation, precipitating factors and outcome of HE. Methods: This was a cross-sectional multicenter inpatient study in cirrhotic patients admitted for HE in four tertiary hospitals in Yaounde (Cameroon) from December 2016 to May 2017. The diagnosis of HE was based on West Haven clinical criteria. The diagnosis of cirrhosis was made using clinical and/or biological, endoscopic and/or ultrasonography signs. Results: A total of 53 patients with HE (mean age: 49.9 ± 18.9 years, 35 Males) were included. The frequency of hospital admission for HE was 4.9%. HE grade III was the most common (37.7%), followed by grades I and II (26.4% and 26.4%, respectively). Grade IV was present in 9.4% of cases. According to the Child-Pugh score, 72.1% of the patients were at stage C and 27.9% at stage B. The main precipitating factors found were: constipation (38.5%), hyponatremia (35.9%), hepatocellular carcinoma (HCC) (31.7%), herbal medicine (28.3%), hypokalemia (25.6%), gastrointestinal bleeding (22.6%) and ascitic fluid infection (spontaneous bacterial peritonitis) (13.8%). In 5.7% of cases, no factor was identified. Mortality rate during hospitalization was 45.3% and was significantly associated with stage III (RR = 11.1; 95% CI: 1.9 - 64.5; p = 0.003) and IV (RR = 24; 95% CI: 1.6 - 40.9; p = 0.01) of HE; Child-Pugh C score (RR = 15.2; 95% CI: 1.7 - 30.1; p = 0.003) and hypokalemia (RR = 12.2; 95% CI: 1.3 - 19; p = 0.01). Conclusion: HE is a common complication during cirrhosis with a poor prognosis. In the majority of cases, a precipitating factor could be determined.
Highlights
Hepatic encephalopathy (HE) associated with cirrhosis is a spectrum of neurological or neuropsychiatric manifestations occurring in patients with hepatic cirrhosis [1]
This study aims to describe the clinical presentation, precipitating factors and outcome of HE
This disorder is classified into 4 stages according to the classification of the West Haven Criteria (WHC), ranging from simple neurological disorders detectable by psychometric tests to coma [3]
Summary
Hepatic encephalopathy (HE) associated with cirrhosis is a spectrum of neurological or neuropsychiatric manifestations occurring in patients with hepatic cirrhosis [1]. There are no specific clinical signs associated with HE. This disorder is classified into 4 stages according to the classification of the West Haven Criteria (WHC), ranging from simple neurological disorders detectable by psychometric tests to coma [3]. Sought to describe the clinical presentation, precipitating factors and outcome of HE among cirrhotic patients. Hepatic Encephalopathy (HE), a common complication of cirrhosis, is associated with a pejorative prognosis. This study aims to describe the clinical presentation, precipitating factors and outcome of HE. The diagnosis of cirrhosis was made using clinical and/or biological, endoscopic and/or ultrasonography signs.
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