Evaluation of Hepatic Encephalopathy Triggers and Outcomes in Chronic Liver Disease: A Regional Perspective

Background: Chronic liver disease (CLD) accounts for a neuropsychiatric complication called hepatic encephalopathy (HE). This study aimed to explore the key precipitating factors in HE and determine how they correlated with disease severity; findings were compared to global trends. Methods: This cross-sectional study was carried out (December 2019 to July 2020) at the Asian Institute of Medical Sciences (AIMS), Hyderabad, Pakistan. A total of 205 patients with secondary HE to CLD were included. Using the consecutive techniques, demographic characteristics, precipitating factors, used liver dysfunction scores (Child-Turcotte-Pugh and Model for End-Stage Liver Disease) were analysed using SPSS version 20. significant associations (p < 0.05) were identified statistically using Chi-square and ANOVA test. Results: Electrolyte imbalances (48%) (n=98), principally hyponatremia (18%) (n=37), were the most frequent precipitating factors, while the most common precipitating factors were infections (35.1%) (n=72) with spontaneous bacterial peritonitis being the most frequent (16.6%) (n=34). In 14.6% (n=30) of cases, gastrointestinal bleeding was observed. Infected and severe electrolyte disturbance (p<0.05) were significantly associated with higher grades of HE (Grade III/IV). Patients with Child C classification and MELD >20 had a more severe history of HE episodes. Infections were more common in older patients (≥60 years), whereas younger patients (<40 years) were more susceptible to dehydration and development of gastrointestinal bleeding. Conclusion: Electrolyte imbalances and infections were the main precipitants. Electrolyte monitoring, infection control, and demographics-specific strategies are paramount to improving patient outcomes.