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Precipitating factors of hepatic encephalopathy in cirrhosis of liver at a tertiary care hospital in north east india

Bikash Narayan Choudhury., Dankan Khanikar and Chitralekha Baruah

Hepatic encephalopathy is a spectrum of neuropsychiatric abnormalities in patients with liver dysfunction, characterized by personality changes, intellectual impairment and altered consciousness. A hospital based observational descriptive study was conducted from June 2013 to May 2014 in Gauhati Medical College, Guwahati, India with an objective to evaluate different precipitating factors of hepatic encephalopathy in patients with liver cirrhosis. Among 112 patients enrolled 86 (76.78%) were male and 26 (23.22%) female with male and female ratio 3.3: 1. 73 (65.17 %) patients were above 40 years of age, 37 (33%) in grade IV, 32 (28.6%) grade III and grade I hepatic encephalopathy. 74 (66%) out of 112 patients had alcoholic cirrhosis. The most common precipitating factors were upper GastroIntestinal bleeding 56 (50%), infection 49 (43.75%), constipation 45 (40.18%) and hypernatremia 45 (40.18%). Single precipitating factor was found in 42 (38%) and more than three factors in 35 (31%). 80 patients recovered while 32 patients expired. Majority of expired patients had Child-Pugh score C, grade IV hepatic encephalopathy and multiple precipitating factors.The study concluded that different precipitating factors play key role in development of hepatic encephalopathy. Upper gastrointestinal bleeding was the most common factor in this study, higher grade of hepatic encephalopathy with multiple precipitating factors having poor prognosis.

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