Abstract
Background: To determine the frequency of factors leading to hepatic encephalopathy (HE) in patients with liver cirrhosis at a tertiary care hospital.
Material & Methods: It is a cross-sectional observation study conducted in the Department of Gastroenterology, Agha Khan University Hospital, from November 2009 to November 2012. 177 cirrhotic patients were included in this study via non-probability, purposive sampling. Data was analyzed using SPSS Version 19.
Results: A total of 177 patients were studied with the mean age of 54 + 11 (range 20-80) years. Out these 70
(40%) were males & 107 (60%) were females. Hepatitis C (HCV) was responsible for cirrhosis in 126 (71%).
Child Turcotte Pugh (CTP) class C was present in 134 (76%), while child B and A were present 41(23%) and 2
(1%) respectively. On presentation, 23(13%) patients had grade 1 HE while 80(45%), 64(36%) and 10(6%) had
grades 2, 3 and 4 respectively. The most common precipitant of HE was electrolytes imbalance in 97 (55%),
Hyponatremia in 95(46%), infections in 96(54%), spontaneous bacterial peritonitis (SBP) in 45 (25%), urinary tract infection (UTI) in 41(23%), respiratory tract infection (RTI) in 14 (8%), constipation in 70(39%) and gastrointestinal bleed in 12(7%). Eighty nine (50.3%) patients had one precipitant, while two precipitant were noted in 79 (44.6%). 146 (82.5%) patients improved clinically and were discharge while 31 (17.5%) patients died in the hospital. The mortality was almost three times high in those who were in child class C, had a more than one precipitants, hyponatremia and in high grade HE at presentation.
Conclusion: The hyponatremia, infections and constipation were the main precipitants of hepatic encephalopathy while frequency of GI bleed related HE had decrease. Patients had high mortality who had grade III/ IV HE at presentation, child C cirrhosis, hyponatremia, and more than one precipitant. Liver transplant is the ultimate treatment in these patients.
Muhammad Sadiq Achakzai, Hafeez ullah Shaikh, Ahsan Mobin, Shahid Majid, Anjum Javed, Abdullah Bin Khalid, Muhammad Tayyab Usmani, Ubedullah Shaikh. (2016) FACTORS LEADING TO HEPATIC ENCEPHALOPATHY IN PATIENTS WITH LIVER CIRRHOSIS AT A TERTIARY CARE HOSPITAL IN KARACHI, PAKISTAN, Gomal Journal of Medical Sciences , Volume 14, Issue 2.
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