Spectrum of Precipitating Factors of Hepatic Encephalopathy in Patients with Liver Cirrhosis in Tertiary Care Hospital in North India

Cirrhosis of liver is a common chronic clinical entity. Hepatic encephalopathy is one of its frequent complication. Often there is an underlying precipitating factor which leads on to encephalopathy. Identifying and managing these factors will improve the quality of life of such patients. Aim- To study patients admitted with hepatic encephalopathy secondary to cirrhosis of liver and to evaluate for the known precipitants. Material and methods- Over a period of one and half year various factors precipitating hepatic encephalopathy in 50 patients with liver cirrhosis were evaluated. Patients were verified for fulfilling inclusion criteria and ruled out for presence of exclusion criteria. Grading of hepatic encephalopathy was done by West Haven Classification and prognostic stratification through Child Pugh score. Results -Gastrointestinal bleed as a precipitant of hepatic encephalopathy was noted among 60 % of patients. Other precipitants include constipation, binge alcohol intake, electrolyte imbalance, infections, overzealous diuretic use, massive paracentesis and use of sedative/psychotropic/hepatotoxic drugs. Most common cause of cirrhosis in this study was alcoholism (66 %).48 % of subjects were grouped in Child Pugh Class C. Conclusion-The result of this study indicates that patients with increased precipitants of hepatic encephalopathy and those who have higher Child Pugh score tend to have worse prognosis. Thus early identification of such precipitating factors and treatment can result in better outcomes. Alcohol emerged as a common cause of cirrhosis of liver and an important precipitating factor for hepatic encephalopathy.