NVA Benhar1, H. Vijaya Kumar2
Hepatic Encephalopathy (HE) is defined as a spectrum of neuropsychiatric abnormalities in patient with liver dysfunction, after exclusion of other known brain diseases. It is a potentially reversible condition. Its spectrum ranges from minimal hepatic encephalopathy without recognisable clinical symptoms or signs to overt hepatic encephalopathy with risk of cerebral oedema and death. The burden of disease for cirrhosis is increasing, especially with regard to the rise in the number of patients with hepatitis C and E or non-alcoholic steatohepatitis.
MATERIALS AND METHODS
Patients with hepatic encephalopathy admitted in Department of Medicine, Government General Hospital, Kakinada were studied during the period of December 2013 - November 2016. Before commencement of study, permission was obtained from Ethics Committee, Rangaraya Medical College, Kakinada. All enrolled patients were informed about the nature of the study and their right to refuse. The informed written consent was taken before including them in the study. Sample Size was 100 patients. This study design was observational study and patients who fulfil the inclusion criteria.
In this study, the commonest cause of hepatic encephalopathy was found to be due to alcoholism (43%), all of them were males. HBV infection was the second commonest cause with 33%, of which 65% were females. In 12% of patients, the cause was HCV infection. Cause was not known in 8% cases of hepatic encephalopathy, which were thought to be NASH/NAFLD. In 4% of patients, both HBV and alcoholism were aetiological factors. Female preponderance was seen in non-alcohol groups, especially in cryptogenic cirrhosis.
Out of 100 patients, 51% recovered and were discharged, 49% of patients expired of which 62% were males and 38% were females. Mortality rate among patients with hepatic encephalopathy in males and females in the present study were 47% and 51% respectively. Females have relatively poor prognosis than male. Higher fatality rate were recorded with increasing severity of encephalopathy. According to West Haven classification out of the 36 patients, 34 expired in Grade IV. Out of the 31 patients, there was no mortality in Grade I hepatic encephalopathy. In Grade IV hepatic encephalopathy, the mortality was more than 80%. The number of patients who expired according to Child-Pugh score were 85% in Class C, 15% in Class B and none in Class A. Mortality of patients in Class C was 70%.
Hepatic Encephalopathy, Clinical Profile, Epidemiology.