Abstract
Background Hepatic encephalopathy (HE) is one of the most debilitating complications of cirrhosis leading to death. Decrease in HE mortality and recurrence has been linked with timely identification and early treatment. There is a need to document the burden, predictors, and treatment outcomes of HE in an adult population with liver cirrhosis in our setting as only reports from resource-endowed countries abound in the literature. This study aimed therefore to determine the prevalence, predictors, and treatment outcomes of patients with liver cirrhosis admitted at St. Dominic Hospital (SDH) in Akwatia, Ghana. Materials and Methods A prospective study was conducted involving one hundred and sixty-seven (167) patients admitted at the medical wards in SDH with liver cirrhosis from January 1st, 2018, to March 24th, 2020. The demographic and clinical features of the patients were collected using a standardized questionnaire. Biochemical, haematological, and abdominal ultrasound scans were done for all patients. Patients were then followed up until discharge or death. Results There were 109 (65.3%) males out of the 167 patients with a mean age of 45.8 and 47.5 years for those with and without HE, respectively. The prevalence of HE was 31.7% (53/167). Out of 53 participants with HE, 75.5% (40/53) died. There was a strong association between HE and death (p < 0.001). The major precipitating factor of HE was infection (64.2%). Severe ascites (OR = 0.009) were clinical feature independently associated with HE, whereas high creatinine (OR = 0.987), blood urea nitrogen (BUN) (OR = 1.199), Child–Pugh score (CPS) (OR = 5.899), and low platelets (OR = 0.992) were the laboratory parameters and scores independently predictive of HE. Conclusion HE was common among patients with liver cirrhosis admitted at SDH with high in-patient mortality. The commonest precipitating factor for HE was infection(s). Severe ascites, low platelet count, high creatinine, BUN, and CPS were independent predictors of HE.
Highlights
Hepatic encephalopathy (HE) is one of the most common complications of liver cirrhosis and is defined as a brain dysfunction caused by liver insufficiency and/or portosystemic shunts, resulting in significant impairment of the quality of life and frequent hospitalisations [1]. e cognitive impairment associated with HE severely affects the lives of patients and their caregivers
Unless the underlying liver disease is successfully treated, HE is associated with poor survival and a high risk of recurrence [3, 4]. e spectrum of HE ranges from minimal brain
HE at admission was observed in 31.7% of patients included in this study. is number is similar to that reported by the CANONIC (34%) and NACSELD (33%) cohorts [17, 18] but lower than that reported by Alexopoulou et al [19]. ese differences are probably explained by the specific characteristics of the cohorts and difficulty in diagnosing minimal HE and by the fact that patients were evaluated very early after admission in this study. e high mortality in our patients may be multifactorial
Summary
Hepatic encephalopathy (HE) is one of the most common complications of liver cirrhosis and is defined as a brain dysfunction caused by liver insufficiency and/or portosystemic shunts, resulting in significant impairment of the quality of life and frequent hospitalisations [1]. e cognitive impairment associated with HE severely affects the lives of patients and their caregivers. Ere is a need to document the burden, predictors, and treatment outcomes of HE in an adult population with liver cirrhosis in our setting as only reports from resource-endowed countries abound in the literature. Is study aimed to determine the prevalence, predictors, and treatment outcomes of patients with liver cirrhosis admitted at St. Dominic Hospital (SDH) in Akwatia, Ghana. A prospective study was conducted involving one hundred and sixty-seven (167) patients admitted at the medical wards in SDH with liver cirrhosis from January 1st, 2018, to March 24th, 2020. Severe ascites (OR 0.009) were clinical feature independently associated with HE, whereas high creatinine (OR 0.987), blood urea nitrogen (BUN) (OR 1.199), Child–Pugh score (CPS) (OR 5.899), and low platelets (OR 0.992) were the laboratory parameters and scores independently predictive of HE. HE was common among patients with liver cirrhosis admitted at SDH with high in-patient mortality. Low platelet count, high creatinine, BUN, and CPS were independent predictors of HE
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