# Hepatic Encephalopathy in the Hepato-Gastroenterology and Internal Medicine Department of General Idrissa Pouye Hospital: A Retrospective Prognostic Study of 69 Cases

## TL;DR

This study analyzed 69 cases of hepatic encephalopathy in a hospital, finding that it often occurs in severe cirrhosis and has a poor prognosis, especially with jaundice and high Child-Pugh scores.

## Contribution

The study provides new insights into the clinical profile and prognostic factors of hepatic encephalopathy in a specific hospital setting in a six-year period.

## Key findings

- Hepatic encephalopathy was most commonly associated with Child-Pugh C cirrhosis and chronic hepatitis B.
- Herbal medicine use, SBP, and gastrointestinal bleeding were the main precipitating factors.
- Jaundice and a Child-Pugh C score were identified as significant predictors of poor outcomes.

## Abstract

Introduction: Hepatic encephalopathy (HE) is a common and severe complication of acute or chronic liver failure. The aim of this study was to describe the epidemiological, diagnostic, therapeutic, and outcome aspects of HE in an internal medicine and hepato-gastroenterology department.

Methods: This was a retrospective descriptive study based on data collected over a six-year period (June 2017 to May 2023) at the hepato-gastroenterology and internal medicine department of Idrissa Pouye General Hospital. All patient records with diagnosed HE were collected. Data were recorded using a standardized survey form, entered, and analyzed with IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). Multivariate analysis was performed using binary logistic regression with a significance level set at p<0.05.

Results: A total of 82 cases of HE were identified among 2480 patients hospitalized during the study period, corresponding to a prevalence of 3.3 %. Thirteen records were unusable, leaving 69 records for analysis. The mean age was 49 ± 16.70 years (range: 17 to 85 years). A male predominance was observed with a sex ratio of 2.45 (49 men, 71.0%). Asterixis (flapping tremor) was present in 41 patients (59.4%). HE was most often classified as West Haven stage II in 41 patients (59.4%). Cirrhosis was present in 57 patients (82.6%), with 51 of these classified as Child-Pugh C (73.9%). The predominant etiology identified among these patients was chronic hepatitis B virus infection. Associated clinical signs were dominated by edematous-ascitic decompensation in 52 patients (75.4%) and jaundice in 51 patients (73.9%). The precipitating factors most frequently associated with the HE episode were herbal medicine use in 22 patients (31.9%), spontaneous bacterial peritonitis (SBP) in 18 patients (26.1%), and gastrointestinal bleeding in 13 patients (18.8%). All patients received treatment based on lactulose and rifaximin. The outcome was marked by death in 53 cases (76.8%), with a mean delay of 7.2 days from symptom onset to death. Multivariate analysis identified a Child-Pugh score of C13 (p=0.043) and the presence of jaundice (p=0.034) as factors associated with poor prognosis.

Conclusion: HE most commonly occurs on a background of severe cirrhosis. Most often precipitated by herbal medicine use, SBP, or gastrointestinal bleeding, the prognosis remains poor, influenced in our study by jaundice and a Child-Pugh C score. Death typically occurs within the first week after symptom onset.