Hepatic Encephalopathy; Prevalence, Precipitating Factors and Challenges of Management in a Resource-Limited Setting

Abstract

Background and Aims: Hepatic encephalopathy, a neuropsychiatric syndrome caused by portosystemic venous shunting, clinical presentation ranges from minimal to overt H.E. It is a common complication of advanced liver disease with significant morbidity and mortality The aim of this study was to assess the prevalence, common precipitating factors, and outcomes of hepatic encephalopathy in patients with preexisting liver disease. Methods: A hospital based, retrospective chart review study was conducted at Bugando Medical Centre a tertiary hospital in Mwanza region. The target population included all patients aged > 18 years admitted with Hepatic encephalopathy from January 2009 to June 2015. Patients were enrolled using a detailed checklist, personal identifications were removed and analysis was done using the SPSS version 17.0. Results: A population of 88 patients with Hepatic encephalopathy were enrolled with a mean of 47 years (SD +/-17 years). Among patients admitted to the medical ward, the prevalence was 0.4% (88/23942). Most common liver disease and complications including alcoholic cirrhosis, hepatitis B infection, and hepatocellular carcinoma were present in 47.7% of (42/88), 22.7% (20/88), and 23.9% (21/88) patients, respectively. Majority had West Haven grade 3, 36.4% (32/88), and grade 4, 18.2% (16/88). Precipitating factors included diuretic therapy on patients with ascites 27.2% (44/162), infections 21.6% (35/162), blood transfusions, 16.7% (27/162), and upper gastrointestinal bleeding 17.3% (28/162). Most died during their hospitalization, 75% (66/88). The remaining 25% (22/88) were discharged. Majority of the cohort, 72.7% (64/88), had less than 3 months survival after diagnosis, while 27.3% (24/88) survived more than 1 year. Conclusions: We found severe Hepatic encephalopathy presenting in patients with preexisting liver disease associated with poor outcomes, posing challenges in management and survival. The use of newer and superior agents like polyethylene glycol, identification of subclinical Hepatic encephalopathy and targeting early removal of precipitating factors is imperative. Screening those at risk of developing Hepatic encephalopathy would likely improve outcomes.