RISK FACTORS OF HEPATIC ENCEPHALOPATHY IN PATIENTS WITH CHRONIC LIVER DISEASE PRESENTING TO SAIDU GROUP OF TEACHING HOSPITAL, SWAT

A AZIZ; W KHAN

doi:10.54112/pjicm.v5i02.136

Authors

A AZIZ Department of General Medicine, Saidu Group of Teaching Hospitals, Swat, Pakistan
W KHAN Department of General Medicine, Saidu Group of Teaching Hospitals, Swat, Pakistan

DOI:

https://doi.org/10.54112/pjicm.v5i02.136

Keywords:

Hepatic Encephalopathy, Chronic Liver Disease, Risk Factors, Gastrointestinal Bleeding, Fever, Respiratory Infection, Cirrhosis.

Abstract

Background: Hepatic encephalopathy (HE) is a serious complication of chronic liver disease (CLD), characterized by neuropsychiatric impairment that significantly increases morbidity and mortality. Identifying key precipitating risk factors is essential for prevention and timely management. Objective: To determine the key risk factors leading to HE in patients with CLD presenting to Saidu Group of Teaching Hospital, Swat, Pakistan. Study Design: Cross-sectional study. Setting: Department of Medicine, Saidu Group of Teaching Hospital, Swat, Pakistan. Duration of Study: 12 July 2024 to 12 January 2025. Methods: A total of 107 patients diagnosed with HE and CLD were enrolled. CLD was confirmed based on clinical features, while HE was diagnosed through neuropsychiatric symptoms and magnetic resonance imaging (MRI) findings. Risk factors, including fever (oral temperature ≥38°C), upper gastrointestinal (GI) bleeding (confirmed by endoscopy), and respiratory tract infections (sputum culture with clinical correlation), were assessed. Data were analyzed using descriptive statistics. Results: The mean age of patients was 49.18 ± 14.59 years. Females constituted 66 (61.7%) and males 41 (38.3%). Among identified risk factors, upper GI bleeding was observed in 52.3% cases, fever in 35.5%, and respiratory tract infections in 12.1%. Conclusion: Upper gastrointestinal bleeding was the most common precipitating factor for HE in patients with CLD, followed by fever and respiratory tract infections. Preventive measures and timely management of these risk factors may reduce the incidence of HE and improve patient outcomes.

References

Man LI, Wang ZQ, Zhang L, Zheng H, Liu DW, Zhou MG. Burden of cirrhosis and other chronic liver diseases caused by specific etiologies in China, 1990–2016: findings from the Global Burden of Disease Study 2016. Biomed Environ Sci. 2020;33(1):1–10. https://doi.org/10.3967/bes2020.001

Moon AM, Singal AG, Tapper EB. Contemporary epidemiology of chronic liver disease and cirrhosis. Clin Gastroenterol Hepatol. 2020;18(12):2650–66. https://doi.org/10.1016/j.cgh.2019.07.060

Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204–22. https://doi.org/10.1016/S0140-6736(20)30925-9

Stine JG, Chalasani N. Chronic liver injury induced by drugs: a systematic review. Liver Int. 2015;35(11):2343–53. https://doi.org/10.1111/liv.12958

Argirion I, Pfeiffer RM, Lam TK, O’Brien TR, Yu K, McGlynn KA, et al. Association between immunologic markers and cirrhosis in individuals with chronic hepatitis B. Sci Rep. 2021;11:21194. https://doi.org/10.1038/s41598-021-00455-8

Gragnani L, Lorini S, Marri S, Basile U, Santarlasci V, Monti M, et al. Hematological and genetic markers in the rational approach to patients with HCV sustained virological response with or without persisting cryoglobulinemic vasculitis. Hepatology. 2021;74(3):1164–73. https://doi.org/10.1002/hep.31804

Bajaj JS, Wade JB, Gibson DP, Heuman DM, Thacker LR, Sterling RK, et al. The multi-dimensional burden of cirrhosis and hepatic encephalopathy on patients and caregivers. Am J Gastroenterol. 2011;106(9):1646–53. https://doi.org/10.1038/ajg.2011.157

Patidar KR, Bajaj JS. Covert and overt hepatic encephalopathy: diagnosis and management. Clin Gastroenterol Hepatol. 2015;13(12):2048–61. https://doi.org/10.1016/j.cgh.2015.06.039

Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014;60(2):715–35. https://doi.org/10.1002/hep.27210

Gerber T, Schomerus H. Hepatic encephalopathy in liver cirrhosis: pathogenesis, diagnosis and management. Drugs. 2000;60(6):1353–70. https://doi.org/10.2165/00003495-200060060-00008

Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT. Hepatic encephalopathy—definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002;35(3):716–21. https://doi.org/10.1053/jhep.2002.31250

Acharya C, Bajaj JS. Current management of hepatic encephalopathy. Am J Gastroenterol. 2018;113(11):1600–12. https://doi.org/10.1038/s41395-018-0179-4

Mahboob F. Frequency of risk factors for hepatic encephalopathy in patients of chronic liver disease. Ann King Edw Med Univ. 2003;9(1):29–30.

Akhtar S, Fakhar Z, Khan S, Nohri AR, Nohario SA, Memon MA. Precipitating factors and outcomes of hepatic encephalopathy in chronic liver disease. J Health Rehabil Res. 2024;4(1):701–5.

Khan AU, Iqbal M, Yasmeen R, Ahmed W. Determination of precipitating factors of hepatic encephalopathy in chronic liver disease. Pak Armed Forces Med J. 2011;61(4):626–9.

Qazi FA, Khan SB, Umar A. Hepatic encephalopathy in chronic liver disease: predisposing factors in a developing country. Asian J Med Sci. 2014;6(2):35–42. https://doi.org/10.3126/ajms.v6i2.11099

Mumtaz K, Ahmed US, Abid S, Baig N, Hamid S, Jafri W. Precipitating factors and outcomes of hepatic encephalopathy in liver cirrhosis. J Coll Physicians Surg Pak. 2010;20(8):514–8.

Sheikh A, Ahmed SI, Naseemullah M. Aetiology of hepatic encephalopathy and importance of upper GI bleeding and infections as precipitating factors. J Rawal Med Coll. 2001;5(1):10–12.

Ahmed H, Rehman M, Saeedi MI, Shah D. Factors precipitating hepatic encephalopathy in cirrhosis liver. J Postgrad Med Inst. 2001;15(1):91–7.