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Hepatic encephalopathy (H.E.) is a reversible syndrome of impaired brain function occurring in advanced liver failure patients. Common precipitating factors include gastrointestinal bleeding, infections, azotemia, constipation, electrolyte imbalance, and high protein diet. Patient outcome relies on early identification of the precipitating cause. Material and methods: A retrospective, case record-based study was done using case records of all patients aged 18 years and above admitted with hepatic encephalopathy from January 2016 to December 2018. Hepatic encephalopathy was graded according to West Haven criteria and severity of liver cirrhosis using Child Turcotte Pugh scoring system. Precipitating factors, CTP score, HE stage were considered as outcome variables. Mortality was considered as explanatory variable. Data was entered in Microsoft excel and analysed with IBM SPSS version 22. Results: The proportion of grade I, II, III, IV H.E. was 3.88%, 36.89%, 39.81%, 19.42% respectively. Mortality was 17.48%. Dehydration was the most common (78.64%) precipitating factor followed by infections seen in 56.57% of the subjects (SBP-31%, UTI-1.94%, respiratory infections – 15.53%), diuretics (46.6%), hypokalemia (35.3%), constipation (33%) and G.I. bleeding (30%). There was no significant association between mortality in HE with duration of disease, dehydration, SBP, respiratory infections, diuretics, malena. Conclusions: Dehydration and infections were the most common precipitating factors in our study, although various factors play a role in precipitating hepatic encephalopathy. Early identification and treatment of precipitating factors and health education among cirrhotic patients, regarding precipitating factors are of paramount importance in the prevention and management of hepatic encephalopathy.

international journal of contemporary medicine surgery and radiology

Clinical Spectrum of Precipitating Factors of Hepatic Encephalopathy in Cirrhosis of Liver and Its Relation to Prognosis in a Tertiary Care Hospital - A Retrospective Study