# Predictors of Mortality in Patients with Hepatic Encephalopathy: A Retrospective Analysis

## TL;DR

This study identifies key factors that predict in-hospital death in patients with hepatic encephalopathy, a serious liver-related condition.

## Contribution

The study provides new insights into specific clinical and laboratory predictors of mortality in hepatic encephalopathy patients.

## Key findings

- Higher MELD scores, elevated ammonia, and advanced HE grades were strongly linked to mortality.
- Renal dysfunction and hyponatremia were more common in patients who died.
- MELD score showed the best ability to predict mortality outcomes.

## Abstract

Background

Hepatic encephalopathy (HE) is a serious neuropsychiatric complication of liver dysfunction associated with significant morbidity and mortality.

Objective

The objective of this study was to evaluate the predictors of in-hospital mortality in patients with HE through retrospective analysis.

Methods

This retrospective observational cohort study was conducted at Punjab Rangers Teaching Hospital, Lahore, Pakistan, from January 2023 to January 2025. A total of 201 adult patients (≥18 years) admitted with a diagnosis of hepatic encephalopathy were included in the study. The diagnosis of HE was made clinically based on the West Haven criteria and supported by biochemical and radiological assessments as needed. Patients with both acute and chronic liver disease were considered, provided they fulfilled the diagnostic criteria for HE. Data were extracted from the hospital’s electronic medical record system using a structured questionnaire. Clinical and laboratory parameters were analyzed to identify predictors of in-hospital mortality using multivariate logistic regression.

Results

The in-hospital mortality rate was 57 (28.4%). Non-survivors had significantly higher Model for End-Stage Liver Disease (MELD) scores (mean 29.3 vs. 24.9, p < 0.001), elevated serum ammonia levels (mean 136.2 µmol/L vs. 103.1 µmol/L, p < 0.001), more frequent renal dysfunction (37 (64.9%) vs. 41 (28.9%), p < 0.001), and hyponatremia (33 (57.9%) vs. 43 (29.6%), p = 0.002). High-grade HE (Grade III/IV) was more prevalent among non-survivors (42 (73.7%) vs. 52 (36.2%), p < 0.001). Independent predictors of mortality included MELD score ≥28, serum ammonia ≥120 µmol/L, renal dysfunction, serum sodium <130 mEq/L, and high-grade HE. The MELD score demonstrated the highest discriminatory ability (area under the curve (AUC) = 0.78).

Conclusion

In patients with HE, higher MELD scores, elevated serum ammonia, renal impairment, hyponatremia, and advanced HE grades are significant predictors of mortality. These findings highlight the importance of early risk assessment and may guide decisions regarding intensive management and liver transplant referral.