Clinical Aspects and Precipitating Factors of Hepatic Encephalopathy Associated with Cirrhosis in a Cameroonian Population

Abstract

Background: Hepatic Encephalopathy (HE), a common complication of cirrhosis, is associated with a pejorative prognosis. This study aims to describe the clinical presentation, precipitating factors and outcome of HE. Methods: This was a cross-sectional multicenter inpatient study in cirrhotic patients admitted for HE in four tertiary hospitals in Yaoundé (Cameroon) from December 2016 to May 2017. The diagnosis of HE was based on West Haven clinical criteria. The diagnosis of cirrhosis was made using clinical and/or biological, endoscopic and/or ultrasonography signs. Results: A total of 53 patients with HE (mean age: 49.9 ± 18.9 years, 35 Males) were included. The frequency of hospital admission for HE was 4.9%. HE grade III was the most common (37.7%), followed by grades I and II (26.4% and 26.4%, respectively). Grade IV was present in 9.4% of cases. According to the Child-Pugh score, 72.1% of the patients were at stage C and 27.9% at stage B. The main precipitating factors found were: constipation (38.5%), hyponatremia (35.9%), hepatocellular carcinoma (HCC) (31.7%), herbal medicine (28.3%), hypokalemia (25.6%), gastrointestinal bleeding (22.6%) and ascitic fluid infection (spontaneous bacterial peritonitis) (13.8%). In 5.7% of cases, no factor was identified. Mortality rate during hospitalization was 45.3% and was significantly associated with stage III (RR = 11.1; 95% CI: 1.9 - 64.5; p = 0.003) and IV (RR = 24; 95% CI: 1.6 - 40.9; p = 0.01) of HE; Child-Pugh C score (RR = 15.2; 95% CI: 1.7 - 30.1; p = 0.003) and hypokalemia (RR = 12.2; 95% CI: 1.3 - 19; p = 0.01). Conclusion: HE is a common complication during cirrhosis with a poor prognosis. In the majority of cases, a precipitating factor could be determined.