FACTORS LEADING TO HEPATIC ENCEPHALOPATHY IN PATIENTS WITH LIVER CIRRHOSIS AT A TERTIARY CARE HOSPITAL IN KARACHI, PAKISTAN

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