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