S3284 Portosystemic Encephalopathy (PSE) Recurrence in Cirrhotic Patients and Its Risk Factors

Abstract

INTRODUCTION: Recurrence PSE in the cirrhotic patients is associated with worse outcomes. It is important to assess the risk factors for recurrent PSE so that appropriate prevention and prognostication can be done. METHODS: It is a retrospective study done in the section of Gastroenterology, The Aga Khan University Hospital, Karachi, Pakistan from Jan 1, 2019, till December 31, 2019. Patients who were admitted with the first time with PSE and admitted within 3 months of index PSE were enrolled in the study. Grading of PSE Grade (I-VI), laboratory tests(Bilirubin, Albumin, Creatinine ), ascites with SBP, gastrointestinal bleeding (GIB), acute kidney injury ( AKI) and( CTP, MELD) were collected by chart review and analyzed by SPSS version 20. RESULTS: Total 61 patients were included in study and 10 were lost to follow up. Mean age was 59+/- 10, male were 58 %. Diabetic were (64%) and 54% were hypertensive. As per etiology HCV (59%) ,HBV(27%), Alcohol(7%),other (7%).Out 51 patients 33 readmitted with PSE, 6 were expired and rest followed in clinic. Risk factors were UTI ( 19%),AKI (15%),Constipation(15%),Hyponatremia(14%),SBP( 12%),Hypokalemia (13%), GIB (8%) .Most of patient were in CTP score C ,(75%),CTP Score B (25%).MELD >18 ( 65%), TB > 3( 41%), >6(10%),< 3(49%) and Albumin >3.5 (42%), < 2.8(20%),2.8-3.5(38%).PSE Grade 1-2( 42%),PSE-3(39%),PSE-4(19%).All patients who were expired were in PSE-4 with raised creatinine >3. CONCLUSION: MELD score >18, raised TB > 6mg/dl, decreased sodium and low Albumin significantly associated with PSE recurrence.