Profile of Hepatic Encephalopathy in Children with Cirrhosis and Response to Lactulose

Background/Aim: Hepatic encephalopathy (HE) is associated with a poor prognosis. There is paucity of data on the treatment of HE with lactulose in children with cirrhosis. Patients and Methods: Retrospective analysis of consecutive cirrhotic patients (<18 years) with HE was done. HE was defined according to West-Haven criteria. Response was defined as complete if patients recovered completely from HE, partial response was defined as improvement of encephalopathy by one or more grades from admission but not complete recovery, and defined as non response if patient did not show any improvement or deteriorated further even after 10 days of lactulose therapy. Results: A total of 300 patients were admitted with cirrhosis and HE (278 adults and 22 children). Of 22 patients, 16 (73%) patients had complete response to lactulose and six (27%) patients did not [three (13.5%) patients worsened (non response) and three (13.5%) did not recover fully even after 10 days of treatment (partial response)]. Comparing baseline characteristics of patients who had complete response (n=16) versus partial (n=3) and non response (n=3), there was significant difference in mean arterial pressure (78.1 +/- 10.7 vs 62.6 +/- 5.0 mmHg, P=0.003), serum sodium (131.3 +/- 3.2 vs 126.5 +/- 5.2, P=0.01) and serum creatinine (0.78 +/- 0.3 vs 1.1 +/- 0.3 mg/dl, P=0.02). We did not find any difference in baseline characteristics of these patients regarding CTP score (9.6 +/- 1.2 vs 10.6 +/- 1.2), MELD score (17.6 +/- 2.9 vs 17.1 +/- 3.4), severity of HE (2.5 +/- 0.6 vs 2.6 +/- 0.5) and etiology of precipitating factors (P=0.78). Conclusions: Lactulose therapy causes complete recovery from hepatic encephalopathy in 73% of pediatrics patients with cirrhosis.