Precipitating Factors and Treatment Outcomes of Hepatic Encephalopathy in Liver Cirrhosis

Nandu S Poudyal,Azad Mojahedi,Sitaram Chaudhary,Sudhamshu Kc,Amrendra Mandal,Paritosh Kafle,Vijay Gayam,Mukesh S Paudel,Bhupendra K Basnet,Barun Shrestha,Baikuntha Chaulagai,Bidhan N Paudel

doi:10.7759/cureus.4363

Abstract

BackgroundHepatic 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.MethodsAll 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 chi-square test was used to compare the different treatment outcomes with hospital stay and mortality with significance at p<0.05.ResultsA total of 132 patients (mean age 49.2 ± 10.2 years; male/female ratio of 103:29) were studied. The most common precipitating factor of HE was infection 65 (49.2%), followed by electrolyte imbalance 54 (41%), constipation 44 (33.33%), and gastrointestinal bleeding 21 (16%) patients. At the time of admission, 29 (22%), 76 (57.5%), 21 (16%), and six (4.5%) patients had grade I, II, III, and IV HE, respectively. The difference in mortality was not statistically significant (p=0.269) in three groups but the hospital stay was shorter among patients in groups B and C than in group A alone (7.36 ± 4.58 and 7 ± 3.69, 9.64 ± 5.28 days, respectively, p=0.015).ConclusionsInfection, especially spontaneous bacterial peritonitis, was the commonest precipitating factor of HE. The combination of lactulose either with LOLA or rifaximin is equally effective in improving HE and reducing the duration of hospital stay than lactulose alone.

Highlights

Liver cirrhosis (LC), the final pathway for a wide variety of chronic liver diseases, is a pathologic entity defined as diffuse hepatic fibrosis with the replacement of the normal liver architecture by nodules [1]
All the liver cirrhosis (LC) patients admitted between February 2017 and January 2018 for overt Hepatic encephalopathy (HE) were analyzed for precipitating factors and treatment outcomes
The difference in mortality was not statistically significant (p=0.269) in three groups but the hospital stay was shorter among patients in groups B and C than in group A alone (7.36 ± 4.58 and 7 ± 3.69, 9.64 ± 5.28 days, respectively, p=0.015)

Summary

Introduction

Liver cirrhosis (LC), the final pathway for a wide variety of chronic liver diseases, is a pathologic entity defined as diffuse hepatic fibrosis with the replacement of the normal liver architecture by nodules [1]. Hepatic encephalopathy (HE) is a well-recognized clinical complication of LC and the presence and prompt identification of well-defined precipitating factors are extremely important in the diagnosis and treatment of this fatal condition. HE develops in 50% to 70% of patients with cirrhosis, and its occurrence is a poor prognostic indicator, with projected one- and three-year survival rates of 42% and 23%, respectively, without liver transplantation [2]. We aimed to study the different combinations of these drugs in our population with lactulose in all the three groups as a standard of care. Hepatic encephalopathy (HE) is a common cause of hospital admission in patients with liver cirrhosis (LC).

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