Clinical Analysis Of Precipitating And Prognostic Factors In Hepatic Encephalopathy: A Report Of 149 Cases

Objectives:To analysis various factors possibly affecting the progress of Hepatic Encephalopathy(HE),evaluate their prognostic values for HE episode.Methods:Retrospective analysis of 149 clinical cases with the diagnosis of HE admitted in The Second Affiliated Hospital of Zhejiang University between February, 2001 and November,2008.The data analysis of sex,age,etiology,precipitating factors,Grades of Child-pugh classification,Stages of HE,the values of PT,Bun,ChE,Ammonia,Na~+,and comparison of their different mortality rates,between the two groups with different prognostic stratification,investigate their relevance with the outcome of HE.Results:For total patients,the mortality rate was 55.7%;120 males(80.5%) and 29 females(19.5%),Average age was 56.01±9.76 ys,the majority lied in the range from 45-55 ys.Hepatitis B cirrhosis(43.3%),alcoholic liver cirrhosis(22.3%),hepatitis B companied by alcoholic liver cirrhosis(8.3%) and hepatitis B cirrhosis complicated with hepatocellular carcinoma(9.6%) were the most common etiologies for HE,while the mortality rate of HE by alcoholic liver cirrhosis was significantly lower than that of hepatitis B cirrhosis and Hepatitis B companied by alcoholic liver cirrhosis.Among these,8(5.1%) patients had been taken a portal-systemic shunt surgery. Infection(23.5%),gastrointestinal(GI) bleeding(15.4%),high protein-diet uptake(13.4%) were the most common precipitating factors invoking an episode of HE,while GI bleeding and a mixture of multi-factors induced the significantly higher mortality rates. For the severity of liver function impairment,there were 15(10.1%) in grade A,43 (28.9%) in B,91(61.1%) in C according to the Child-pugh classification,and the mortality rised significantly as the grade ascending.The grade of HE wasⅠin 25(16.8%) patients,Ⅱin 95(63.8%),Ⅲin 14(9.4%) andⅣin 15(10.1%),also the mortality raised up with the accordance of grade lifted up significantly.When all the variables introduced into the multi-variate analysis,hepatitis B companied by alcoholic liver cirrhosis,metastastic hepatic carcinoma,GI bleeding,multi-precipitating factors,level of ChE,stage of HE were counted in for predicting the outcome of HE.Prothrombin (PT),blood urea nitrogen(Bun) increased significantly when cholinesterase(ChE) and serum sodium significantly decreased in the death group.Though the level of ammonia was higher in the death group,but it did not have a significant difference.Conclusions:HE were more common seen in male,and its peak age lied in the middle-aged and the elderly.The major etiology of HE was all kinds of liver cirrhosis, when the most common one was hepatitis B cirrhosis.The common precipitating factors were Infection,gastrointestinal bleeding and high protein-diet uptake,hepatitis B companied by alcoholic liver cirrhosis,metastastic hepatic carcinoma,gastrointestinal bleeding,multi-precipitating factors,level of ChE,stage of HE were counted in for predicting the outcome of HE.The level of ammonia had little value in predicting the prognosis of HE while Hyponatremia,the level of PT,Bun and ChE counted for more. Prevention and treatments in intervening the relavent factors as mentioned above timely were the key managements for improving the outcome of HE.