PREDICTORS OF OUTCOME IN PATIENTS WITH TYPE C HEPATIC ENCEPHALOPATHY

Background: Hepatic encephalopathy is a spectrum of neuropsychiatric manifestations observed in patients with hepatocellular dysfunction. We conducted this study to determine the outcome of patients with type C hepatic encephalopathy. Methods: This descriptive study was conducted in Gastroenterology Unit, PGMI Hayatabad Medical Complex Peshawar from January 2009 to June 2010. A total of 316 patients presenting with type C hepatic encephalopathy were included. Those with type A and B encephalopathy and toxic/metabolic encephalopathy were excluded. Patients were graded according to West-Haven criteria (I-IV). Precipitating cause was determined from history, examination and relevant investigations. Outcome was defined in terms of morbidity and mortality. All patients received the standard treatment. Results: Out of 316 cirrhotics, 167(52.8%) were males and 149(47.2%) females with mean age 53 +/- 12.4years. Constipation was the most common precipitating factor for encephalopathy occurring in 231(78.1%) patients, followed by esophageal variceal bleed and infection in 47(14.8%) and 38(12.1%) patients respectively. Out of these, 276(87.3%) had West-Haven stage I-III and 40(12.7%) stage IV encephalopathy. Mean duration of hospital stay was 5 +/- 2 days in patients with West-Haven stage IV and 4 +/- 2 days in West-Haven stage I-III. The overall mortality was 8(2.5%) with West-haven stage I-III encephalopathy and 39(97.5%) with stage IV encephalopathy and esophageal variceal bleed with hemoglobin less than 5gm/dl (p < 0.003). Conclusion: West-Haven stage IV and esophageal variceal bleed as the precipitating cause in type C hepatic encepalopathy is associated with high morbidity and mortality.