Outcome Of Hepatic Encephalopathy Research Articles

Etiology and Outcome of Hepatic Encephalopathy in Bangladeshi Children

Hepatic encephalopathy is one of the complications of liver failure which causes increase mortality and morbidity in children. This cross sectional type of observation study was conducted in the department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University of Bangladesh to determine the etiology and outcome of hepatic encephalopathy in Bangladeshi children. Patients between 1 to 18 years were included who fulfilled the West Heaven clinical criteria of hepatic encephalopathy. The data were collected and recorded questionnaire after IRB approval and was analyzed accordingly. Total 32 patients were included in this study; among which 20 were males and 12 were female with a mean age was 8.1±3.5 years. The most common etiologies were Wilson disease (47%), followed by cryptogenic (25%) and Hepatitis A virus (18.8%). Total 9 patients out of 32 were expired, another 8 got discharge with advice, 1 patient recovered after liver transplantation and others were improved with advice of follow up. All the patients were expired who developed hepatic encephalopathy due to Hepatitis A virus except one patient who received liver transplantation from abroad. This study highlights that hepatic encephalopathy from infective diseases as hepatitis A virus leads higher mortality rate in children. Though liver transplantation facility is not available in the developing countries, maintenance of hygiene and vaccination is the main preventive measures to reduce the mortality in children. Bangabandhu Sheikh Mujib Med. Coll. J. 2023;2(2):88-91.

Diabetes mellitus in association with hepatic encephalopathy in patients with hepatitis C virus cirrhosis: correlation with ICU outcome

Background There is growing evidence to support the concept that hepatitis C virus (HCV) infection is a risk factor for developing type 2 diabetes mellitus (T2DM) and that diabetes control could affect the prognosis of hepatic encephalopathy.Objective To study the relation between type of DM and HCV cirrhosis and to report any relationship between the outcome of hepatic encephalopathy and the glycemic control in the period before precipitation of encephalopathy.Patients and methods A total of 30 selected diabetic, HCV cirrhotic patients with age ranging from 43 and 70 years (mean, 55.87 years), admitted to the ICU for hepatic encephalopathy, were prospectively enrolled in this study. Cirrhosis was evaluated according to Child classification, whereas encephalopathy was evaluated according to West Haven criteria as well as Richmond agitation sedation score. Glycated hemoglobin was used to assess the glycemic control in the period before precipitation of encephalopathy.Results T2DM was more prevalent than type 1 in association with HCV (83.3% T2DM and 16.7% T1DM). Diabetes control plays no role in increasing the severity of cirrhosis (nonsignificant, with P & 0.249). The diabetic HCV cirrhotic patients admitted for hepatic encephalopathy had shorter ICU stay when DM was well-controlled medically in the period before precipitation of encephalopathy (P & 0.001). Moreover, the mortality was decreased markedly in association with diabetes control (P & 0.01).Conclusion HCV viremia had a higher risk of T2DM than T1DM. Diabetes control has no role in increasing the severity of HCV cirrhosis. In HCV cirrhotic diabetic patients, well- controlled DM could improve the ICU outcome (shorter ICU stay and less mortality) when admitted for hepatic encephalopathy.

Clinical Profile, Precipitating Factors and Outcome of Hepatic Encephalopathy in Patients with Liver Cirrhosis

Introduction: Hepatic encephalopathy (HE) is characterized by reversible neuropsychological features and is observed with advanced and decompensated cirrhosis of the liver. Patients outcomes and survival depends on clinical presentation, identification of the precipitating factor, early management, and treatment of complications. This study aims to find out the clinical profile of cirrhotic patients with hepatic encephalopathy, their precipitating factors, and clinical outcomes in patients admitted at a tertiary care Teaching Hospital in Gandaki province, Nepal.
 Materials and Methods: An observational, cross-sectional, hospital-based prospective study comprising of 140 cirrhotic patients with encephalopathy was conducted over a study period of 18 months. Their clinical profile, precipitating factors, and outcomes during hospitalization including mortality were studied. The data analysis was done using SPSS version 20 and a P-value of ≤0.05 was considered significant.
 Results: Majority (36.5%) of the patients presented with Grade II HE. Upper gastrointestinal (GI) bleeding and spontaneous bacterial peritonitis were the most common precipitating factors. Inpatient mortality was 22.9%. The increased mortality rate was observed in patients with Child class C and with higher grading (Grade III and IV) of hepatic encephalopathy and in presence of more than two precipitating factors
 Conclusion: Most of the patients presented with Grade II HE. Upper gastrointestinal bleed and infections were the most common precipitating factors. Patients with Hepatic encephalopathy of Grades III and IV, those with CTP Child class C, and in presence of more than two precipitating factors have high mortality.

Effect of Serum Ammonia, TNF-Alfa and IL-6 Levels on the Degree and Outcome of Hepatic Encephalopathy in Egyptian Cirrhotic Patients

Abstract Background: Hepatic Encephalopathy (HE) is a major complication of liver cirrhosis characterized with neuropsy-chiatric symptoms it's etiology is multifactorial. Aim of Study: Aim of the study serum ammonia, TNF-alfa and IL-6 levels on the degree and outcome of hepatic encephalopathy in Egyptian cirrhotic patients. Patient and Methods: The study included 90 patients with liver cirrhosis complicated with HE (patients group) and 60 cirrhotic patients without HE as control group (group 3), the patients group divided into subgroups according to the grade of encephalopathy from the beginning the study, group A encephalopathy: Grade 1 and 2 and group B encephalopathy: Grade 3 and 4. All patients were followed-up for 7 days, then divided into 2 groups according to the response to treatment; group 1: Complete recovery and group 2: With improper response. Results: There were statistical difference between patients groups (group 1and 2) and control group (group 3) in terms of blood ammonia levels (67.5±22.5, 13±4.8), serum TNF-a levels (21.6±3.2, 2.3±.2) and mean serum IL-6 (63.9±15.9, 4±1.29) respectively. There were statistical difference between group 1 and group 2 in terms blood ammonia levels (46±12.8, 86.5±30.5), mean serum TNF-a levels (7.1±2.9, 29.4±13.3) and mean serum IL-6 (19±9.2, 93.9±20.9). Results also, showed statistical significant difference between group 2A and group 2B in terms of blood ammonia level (79.2±20.6, 173.7±38.7), mean serum TNF-a levels (18.1±5.3, 39.9±14.5) and mean serum IL-6 levels (69.2±11.1, 118.2±13.8). In group 2 there were significant positive correlation between serum TNF with blood ammonia level (r=0.843, p=0.001), serum IL-6 (r=0.732, p=0.001) and between IL-6 and blood ammonia level (r=0.699, p=0.001). Conclusion: There is a strong relation between high blood level of ammonia, TNF alfa, IL-6 and grade and outcome of HE in cirrhotic patients.

Clinico-etiological profile and outcome in hepatic encephalopathy

Clinico-etiological profile and outcome in hepatic encephalopathy

Precipitating factors and the outcome of hepatic encephalopathy in liver cirrhosis.

To determine precipitants of hepatic encephalopathy (HE) and their impact on hospital stay and mortality. Cross-sectional, analytical study. The Aga Khan University Hospital, from January 2005 to December 2007. Consecutive patients admitted with different grades of HE were evaluated between January 2005 and December 2007. The precipitants of HE were correlated with the different grades of HE, and length of hospital stay and mortality. Chi-square test was used to compare the proportion of precipitating factors versus hospital stay and grade with significance at p<0.05. Of the 404 patients 252 (62%) were males. Hepatitis C virus was the cause of cirrhosis in 283 (70%); Child Turcotte Pugh (CTP) class C was present in 317 (78%) patients. On presentation, 17% patients had grade 1 HE while 44%, 29% and 10% had grades 2, 3 and 4 respectively. The most common precipitant of HE was spontaneous bacterial peritonitis in 83 (20.5%), constipation in 74 (18.3%) and urinary tract infection in 62 (15.3%). One hundred and forty (35%) patients had (3) 2 precipitating factors while no precipitant was noted in 50 (12%) patients. Mean hospital stay was 4+/-3 days. The lesser the number of precipitants, shorter was the length of stay (p<0.01) and lesser was the grade of HE (p=0.025). Complete reversal of HE was noted in 366 patients (91%) while the remaining had grade 1 HE on discharge. Nine (2.2%) patients died during the hospital stay. No mortality was noted in patients without precipitants. Patients presenting with (3) 2 precipitating factors and advanced grade of HE had a prolonged hospital stay. Moreover, patients without precipitants had better outcomes.

Importance of nutritional support in patients with hepatic encephalopathy

Protein calorie malnutrition is frequently a complication in the chronic liver disease patient and is considered to be a negative prognostic factor. Anorexia and several other endocrine metabolic complications produce an hypermetabolic state that needs more caloric intake. Hepatic encephalopathy is one of the developments possible in patients with descompensated cirrhosis. The wellknown role of ammonia in the pathogenesis of hepatic encephalopathy has determined a restriction in dietary protein along many decades. Nevertheless, there is no evidence about a low protein diet being better in the outcome of hepatic encephalopathy, it worsens, moreover, the nutritional status and helps in the development of many nutritional related complications. This article reviews the use of oral branched-chain amino acids and proteins of different sources, probiotics, synbiotics, antioxidants, oral L-Ornithine L-Aspartate and acetyl-L-carnitine in patients with hepatic encephalopathy.

Importancia de la nutrición en enfermos con encefalopatía hepática

Protein calorie malnutrition is frequently a complication in the chronic liver disease patient and is considered to be a negative prognostic factor. Anorexia and several other endocrine metabolic complications produce an hypermetabolic state that needs more caloric intake. Hepatic encephalopathy is one of the developments possible in patients with descompensated cirrhosis. The well-known role of ammonia in the pathogenesis of hepatic encephalopathy has determined a restriction in dietary protein along many decades. Nevertheless, there is no evidence about a low protein diet being better in the outcome of hepatic encephalopathy, it worsens, moreover, the nutritional status and helps in the development of many nutritional related complications. This article reviews the use of oral branched-chain amino acids and proteins of different sources, probiotics, synbiotics, antioxidants, oral L-Ornithine L-Aspartate and acetyl-L-carnitine in patients with hepatic encephalopathy.