Precipitating factors of hepatic encephalopathy: An experience at Mansoura Specialized Medical Hospital, Egypt

Abstract

Background/Aim: Hepatic encephalopathy (HE) is a frequent complication of liver cirrhosis, and its development heralds a poor prognosis as it is associated with shortened patients' survival. Reversibility of the precipitating factors of HE is of prognostic significance. This work was designed to study the precipitating factors of HE in patients with liver cirrhosis at Mansoura Specialized Medical Hospital, Egypt. Materials and Methods: A total of 237 consecutive known chronic liver disease patients, presented with signs and symptoms of hepatic encephalopathy, were admitted in the hepatology unit of Mansoura Specialized Medical Hospital from September 2009 to September 2010. The precipitating factors of hepatic encephalopathy were identified with the aid of clinical examination and appropriate investigations. Grades of HE and Child-Pugh scores were determined. Results: The precipitating factors of HE in our studied cases were upper GI bleeding in 87 patients (36.7%), advanced HCC in 43 patients (18.14%), infections in 37 patients (15.61%), excess protein intake in 27 patients (11.39%), electrolyte imbalance in 7 patients (2.95%), and altered bowel habits in 33 patients (13.92%). Males were commonly affected by HCC (P < 0.05) and upper GI bleeding more than female patients (P < 0.05). Male patients were commonly presented with HE (63.29%), and this gender difference reached a statistical significance among those presented with upper GI bleeding (P < 0.05) and HCC (P < 0.05). Upper GI bleeding, advanced HCC, and infections were the leading causes of death with a higher prevalence in grade IV comatose (P < 0.05), child C (P < 0.05), male patients (P < 0.05). Conclusions: Our data revealed that upper GI bleeding, advanced HCC, and infections are the main precipitating factors of HE as well as the major leading causes of death in patients with liver cirrhosis. Priority should be given to control these factors by allocation of the hospital funds, medications, and human efforts. Implementation of an effective screening program for early HCC detection all over the country should be on the top of the official health concerns.