Retrospective Analysis Of Infectious Precipitating Factors In Cirrhosis With Hepatic Encephalopathy

Objective: We analyzed the infectious precipitating factors of cirrhosis with hepatic encephalopathy (HE) and classified the infection, in order to identify the most common site of infection, and provide the basis for early diagnosis, early prevention and effective treatment of HE.Methods:92 patients of hepatitis B virus related cirrhosis with HE(HBCE) with complete data in the First Affiliated Hospital of Dalian Medical University during March 2002 and March 2011 were enrolled in the study. In the same time we selected 45 patients of alcoholic cirrhosis with HE(HACE) with complete data as the control group. We collected the precipitating factors of HE and recorded the site of infection of patients whose precipitating factors were infection. We recorded the first routine blood test after admission. We made a comparative analysis of above data to find out the most common precipitating factor of cirrhosis with HE and the most common site of infection.Results1. Of the 92 HBCE patients, there were 37 cases whose precipitating factors were infection, accounting for 40.22%. Of the 92 HACE patients, there were 16 cases whose precipitating factors were infection, accounting for 35.56%. There was no statistical difference between the two groups.2. Among the 53 patients whose precipitating factor were infection, 30 cases(56.6%) had respiratory tract infection, 11 cases(20.7%) had intestinal tract infection, 9 cases(17.0%) had peritoneal infection, and 3 cases(5.7%) had urinary tract infection. We compared between every two infectious sites, finding there was significant difference(P<0.05) between the respiratory tract and intestinal tract, or peritoneum , or urinary tract, and respiratory tract infection was more common than other sites. There was no statistical difference(P>0.05) between intestinal tract and peritoneum. There was significant difference(P<0.05) between the intestinal tract and urinary tract, and the intestinal tract infection was more common than urinary tract. There was no statistical difference(P>0.05) between urinary tract and peritoneum.3. From analysis of the routine blood test of 53 patients whose precipitating factor were infection, we could find that white blood cell(WBC) count increased in 17 cases, accounting for 32.1%, normal in 24 cases, accounting for 45.3%, and decreased in 12 cases, accounting for 22.6% .There were 39 cases whose proportion of neutrophil increased, accounting for 72.2%. We compared WBC count according to different site of infection and found that there were significant differences(P<0.05) between the respiratory tract and intestinal tract, or peritoneum , or urinary tract, WBC count was lesser when patients have respiratory tract infection. There were no statistical differences(P>0.05) between intestinal tract and peritoneum, or urinary tract. There was no statistical difference(P>0.05) between peritoneum and urinary tract.Conclusions1. Infection is the most common precipitating factor to induce HE, early diagnosis, early prevention and treatment of infection may decrease the incidence of hepatic encephalopathy.2. The respiratory tract infection is the most common infection as precipitating factor among patients of cirrhosis with HE, and preventing and controlling the respiratory tract infection may decrease the incidence of HE.3. WBC count of patients with cirrhosis is not always increased when infection occurs; and we should be wary of infection when WBC count of patients with cirrhosis is higher than their base levels and whose proportion of neutrophil is higher than normal level. .