Onyekwere C A, Ogbera A O, Hameed L
Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Nigeria.
Niger J Clin Pract. 2011 Apr-Jun;14(2):181-5. doi: 10.4103/1119-3077.84011.
Hepatic encephalopathy (HE) is an important neuropsychiatry complication of liver disease causing significant morbidity and mortality worldwide. Efforts at improving the outcome have resulted in development of new strategies in the management given the background of new insights in the pathogenesis of this disease entity. Understanding the disease profile including precipitants as well as prognostic factors will contribute in this regard as new strategies are yet to be widely applied. The aim of this report is to document the profile of patients with HE, the precipitants, prognostic factors as well as the scope of the burden associated with it.
In this prospective study, all patients managed for HE from January to December 2008 were recruited. A questionnaire was used to extract their basic demographics, clinical features noting any possible precipitants, complications, management protocol as well as outcome.
A total of 21 subjects (11 females and 10 males) within the age range of 16-83 years were seen during the period under review. (mean age 57.9 ± 13). There was no significant difference in the mean ages of males and females. Two patients had acute encephalopathy, while others had acute-on chronic encephalopathy. The risk factors for liver disease included significant alcohol ingestion, hepatitis B virus infection, and previous jaundice, while other complications of liver disease noted were deepening jaundice, ascites, bleeding tendencies, and renal failure. The identified precipitants for HE were sepsis 6 (29%), electrolyte inbalance 3 (14%), gastrointestinal bleed 5 (24%), drugs (5%), and possible malignant transformation 6 (29%). Focus of sepsis was bacterial peritonitis in two cases. Majority of our patients (61%) came during advanced stage of liver disease (Child-Pugh class C). Length of hospital stay ranged from 1 to 7 weeks and a mortality of 48% was observed. Predictors of mortality were a history of significant alcohol ingestion, previous blood transfusion, Hepatitis B and C infections, and severe liver dysfunction on presentation (Child-Pugh class C).
HE is associated with a high mortality rate and this scenario is associated with a history of previous blood transfusion, Hepatitis B and C infections, and severe liver dysfunction on presentation. Measures to reduce the burden of viral Hepatitis B and C, safe blood transfusion, and responsible use of alcohol should be promoted. Screening of those at risk of encephalopathy (liver disease patients) with a psychometric test of good predictability should be part of their routine evaluation in daily practice so as to detect cases of latent encephalopathy. Intensive care facilities and necessary personnel should be provided.
肝性脑病（HE）是肝脏疾病重要的神经精神并发症，在全球范围内导致显著的发病率和死亡率。鉴于对该疾病实体发病机制有了新的认识，为改善其预后所做的努力促使了管理方面新策略的发展。了解包括诱发因素和预后因素在内的疾病概况将在这方面有所帮助，因为新策略尚未得到广泛应用。本报告的目的是记录肝性脑病患者的概况、诱发因素、预后因素以及与之相关的负担范围。
在这项前瞻性研究中，招募了2008年1月至12月期间所有接受肝性脑病治疗的患者。使用问卷提取他们的基本人口统计学信息、临床特征，记录任何可能的诱发因素、并发症、管理方案以及结局。
在审查期间共观察到21名受试者（11名女性和10名男性），年龄在16 - 83岁之间（平均年龄57.9±13岁）。男性和女性的平均年龄无显著差异。两名患者患有急性脑病，其他患者患有慢性脑病急性发作。肝脏疾病的危险因素包括大量饮酒、乙型肝炎病毒感染和既往黄疸，同时观察到的肝脏疾病其他并发症有黄疸加深、腹水、出血倾向和肾衰竭。确定的肝性脑病诱发因素为败血症6例（29%）、电解质失衡3例（14%）、胃肠道出血5例（24%）、药物（5%）以及可能的恶性转化6例（29%）。两例败血症的病灶为细菌性腹膜炎。我们的大多数患者（61%）在肝病晚期（Child-Pugh C级）前来就诊。住院时间为1至7周，观察到的死亡率为48%。死亡率的预测因素为大量饮酒史、既往输血史、乙型和丙型肝炎感染以及就诊时严重肝功能不全（Child-Pugh C级）。
肝性脑病与高死亡率相关，这种情况与既往输血史、乙型和丙型肝炎感染以及就诊时严重肝功能不全有关。应推广减轻乙型和丙型病毒性肝炎负担、安全输血以及合理饮酒的措施。对有脑病风险的人群（肝病患者）进行具有良好预测性的心理测试筛查应成为日常实践中他们常规评估的一部分，以便检测潜在脑病病例。应提供重症监护设施和必要人员。
