Predictive Factor for Hepatic Encephalopathy in Cirrhotic Patients Who Presented with Acute Variceal Bleeding

Attapon Rattanasupar MD*, Narumon Tiawijit MD**, Benthira Rachatapantanakorn PhD***

Affiliation : * Division of Gastroenterology, Hat Yai Hospital, Songkhla, Thailand ** Department of Internal Medicine, Hat Yai Hospital, Songkhla, Thailand *** Department of Health Service System Development, Hat Yai Hospital, Songkhla, Thailand

Background : Cirrhotic patients who were hospitalized due to acute variceal bleeding and subsequently developed hepatic encephalopathy during hospital stay had dreadful outcome and high mortality rate. Recommendations regarding management and prevention of encephalopathy in these patients are not available in the current clinical practice guidelines. Defining high-risk patients could possibly prevent or early detect hepatic encephalopathy and help develop prophylactic management.
Objective : To evaluate the potential of certain clinical predictors of hepatic encephalopathy in cirrhotic patients presented with acute variceal bleeding. Material and Method: The medical records of cirrhotic patients with diagnosis of acute variceal bleeding by endoscopy were retrospectively examined for clinical parameters. Potential predictive factors for hepatic encephalopathy were identified by univariate and multivariate analysis.
Results : One hundred seventy four cirrhotic patients who presented with acute variceal bleeding were enrolled in the present study. Hepatic encephalopathy was developed in 25 patients (14.4%). Multivariate analysis showed cirrhosis Child C, serum potassium <3.5 mmole/L, WBC >10,000 cells/mm3, and hemoglobin <8 gm/dL on the day of admission were significant factors predicting hepatic encephalopathy in cirrhotic patients presenting with acute variceal bleeding (adjusted odds ratio 36.7, 9.25, 4.91, and 4.52, respectively). Cirrhotic patients presented with acute variceal bleeding who developed hepatic encephalopathy had higher rate of infection (40% vs. 5.4%), respiratory failure (20% vs. 2%), unit of red blood cell transfusion (3.81.8 units vs. 2.61.8 units), volume of fresh frozen plasma transfusion (1,000 (0-4,000) cc vs. 500 (0-5,000) cc), length of stay (9.03.5 days vs. 5.61.8 days), and mortality rate (8% vs. 0.7%), than non-hepatic encephalopathy p-value <0.05.
Conclusion : Cirrhotic patients presented with acute variceal bleeding with cirrhosis Child C, serum potassium <3.5 mmole/L, WBC >10,000 cells/mm3, and hemoglobin <8 gm/dL were significant predictors for development of hepatic encephalopathy. Cirrhotic patients with acute variceal bleeding who developed hepatic encephalopathy had high morbidity and mortality rates.

Keywords : Predictor, Cirrhosis, Acute variceal bleeding, Hepatic encephalopathy

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