Prevalence and Precipitants of Hepatic Encephalopathy in Hospitalized Children With Chronic Liver Disease

Abstract

ObjectiveHepatic encephalopathy (HE) is a marker of poor prognosis in adults with chronic liver disease (CLD). We prospectively studied the prevalence and precipitants of HE in children with CLD as there is a paucity of literature on the same. MethodsChildren (1-18years) admitted with CLD were examined daily for the presence and grading of HE (West Haven/ Whitington grading). Precipitants were classified as infection, dyselectrolytemia, gastrointestinal bleeding, constipation, and dehydration. Changes in grades of HE and outcome were noted. ResultsOne hundred and sixty children (age 120[84-168] months) were enrolled. HE was present in 50(31.2%) patients with a total of 61 episodes. Maximum grade of HE was grade I (n=16), II (n=23), III (n=11) and IV (n=11). Forty-two cases had single and 8 had recurrent (2-5) episodes. Median duration of HE episodes was 96 (72-192) hours. Precipitants were identified in 55/61(90.2%) episodes with infection (45/61, 73.7%) and dyselectrolytemia (33/61,54%) being most common. Lower albumin and sodium, higher INR and presence of infection were significantly associated with presence of HE. Overall, HE resolved in 33(54%) episodes, while it progressed and persisted in 28(45.9%) episodes. Patients with HE had a poorer outcome (25/50 vs 13/110; p <0.01) with both higher in-hospital (11/50 vs 9/110; p=0.02) and 1month post discharge (14/39 vs 4/101; p<0.01) mortality than those without HE. ConclusionOne third of admitted CLD children have HE, with identifiable precipitants in 90% cases. Children with HE have poorer liver functions, higher rate of infections and worse outcome than those without HE.