Analysis Of Clinical Features And Prognostic Factors Of Hepatic Encephalopathy

ObjectiveIn order to improve the understanding of the etiology,predisposition and prognostic risk factors of HE and provide evidence for early prevention,diagnosis,treatment and prognosis of HE,we retrospectively analyzed the clinical data of patients with Hepatic Encephalopathy(HE)in our hospital in the past 7 years and focused on analyzing the risk factors related to prognosis of patients.Data and MethodsA retrospective study was conducted among HE patients who were hospitalized in the First Affiliated Hospital of Dalian Medical University from January 2012 to December 2018 and met the diagnostic criteria of the Consensus on Diagnosis and Treatment of Hepatic Encephalopathy in China(2013,Chongqing)and Guidelines on the Management of Hepatic Encephalopathy in Cirrhosis.For the patients who were repeatedly hospitalized for HE,only the first admission medical records were collected,and finally 238 patients were included in the study.According to the survival state of the patient at the time of discharge,the patients were classified to survival group and the death group.Clinical data of patients were collected detailedly,including gender,age,place of residence,smoking history,drinking history,underlying diseases,etiology,incentives,liver function grading,HE staging,MELD scores,and relevant important laboratory serological indicators,and then statistical analysis was performed.The clinical indicators of the two groups were compared and analyzed.The statistically significant(P<0.05)variables were included in the binary logistic regression analysis to explore the risk factors affecting the prognosis of HE.Results1.General data: Among the 238 HE patients enrolled in this group,male: female was 155:83(1.87:1),of which 157 survived and 81 died,with the overall mortality rate of 34%.The proportion of male patients in the death group was higher than female 60:21.(2.86:1),and the difference was statistically significant(P<0.05).The age distribution was between 30-88 years old with an average age of 62.51±12.14 years old,and HE patients aged over 45 years old were 219(92%),which had the most patiens;there was no significant difference in mortality between different age groups(P>0.05).2.The main cause of HE: There are a total of 198 cases(83%)based on cirrhosis;55 cases(23.1%)of hepatitis B cirrhosis with mortality rate of 12.7%;26 cases(10.9%)of hepatitis B cirrhosis combined with hepatic cell carcinoma with mortality rate of 61.5%;alcoholic cirrhosis of 28 cases(11.8%)with mortality rate of 25%;cryptogenic cirrhosis of 25 cases(10.5%)with mortality rate of 16%;primary biliary cirrhosis of 21 cases(8.8%)with mortality rate of 33%;acute liver failure of 20 cases(8.4%)with mortality rate of 80%.3.Precipitating factor : 90.3%(215/238)patients had definite precipitating factors;there was a statistically significant difference in mortality among the three groups including the no precipitating factor group,the single precipitating factor group,and the multiple precipitating factors(P<0.001);the main precipitating factor included infection(127 cases,53.4%),including pulmonary infection and peritoneal infection,accounting for 41.7% and 26% respectively;upper gastrointestinal bleeding in 60 cases(25.2%);electrolyte imbalance in 59 cases(24.8%);high protein diet in 31 cases(13.0%);diarrhea and constipation in 26 cases(10.9%);surgery in 13 cases(5.5%);other(drinking,oral sedative drugs)in 10 cases(4.2%).The proportion of death group combined with infection,upper gastrointestinal bleeding and electrolyte imbalance was higher than the survival group,and the difference was statistically significant(P<0.01).4.Child-Pugh classification and HE staging: The patients in this study were classified according to Child-Pugh,9 cases(3.8%)in grade A,0 cases(0%)in death;69 cases(29.0%)in grade B,10 cases(14.5%)in death;160 cases(67.2%)in grade C,71 cases(44.4%)in death;the difference in mortality among the three groups was statistically significant(P < 0.001).There were 66 cases(27.7%)in stage I of HE,3 cases(4.5%)in death;109 cases(45.8%)in stage II,39 cases(35.8%)in death;45cases(18.9%)in stage III,24 cases(53.3%)in death;18 cases(7.6%)in stage IV,15cases(83.3%)in death;the mortality of the four groups increased gradually,the difference was statistically significant(P<0.001).5.The relationship between other influencing factors and prognosis: In this study,the proportion of drinking,hepatorenal syndrome,spontaneous bacterial peritonitis,and hepatic cell carcinoma in the death group were significantly higher than those in the survival group,the difference was statistically significant(P<0.05).6.Characteristics of laboratory indicators between the two groups: The scores of ALT,AST,TBIL,APTT,PT,INR,WBC,NEUT,PLT,Cre,Urea and MELD score in the death group were significantly higher than those in the survival group,and the difference was statistically significant(P<0.05).The PTA and serum sodium(Na)of the patients were significantly lower than the survival group,and the difference was statistically significant(P<0.01)7.Results of binary Logistic regression analysis: HE stage(OR=4.014,95% C=1.781-9.045,P=0.001),upper gastrointestinal bleeding(OR=16.800,95%Cl=3.702-76.249,P<0.001),hepatorenal syndrome(OR=6.106,95% Cl=1.361-27.395,P=0.018),MELD score(OR=1.371,95%Cl=1.101-1.707,P=0.005)were independent risk factors for the prognosis of HE.Conclusion1.In this study,HE patients were more common in men,and the prognosis of men was worse than that of women,the middle-aged and elderly populations were high-risk,and the overall mortality rate was 34%.2.Different types of cirrhosis are the main causes of HE,hepatitis B cirrhosis is the most common cause of cirrhosis,once combined with hepatic cell carcinoma,the prognosis is poor,acute hepatic failure has the highest mortality among the main causes of HE.3.The results of this study indicate that the vast majority of patients with HE had definite precipitating factors,and can be induced by multiple precipitating factors.As the number of the precipitating factors increases,the prognosis was poor.Infection was the main cause,so active prevention and treatment of infection can improve the prognosis of HE and reduce the incidence of HE.4.The elevation of ALT,AST,TBIL,APTT,PT,INR,WBC,NEUT,PLT,Cre,Urea,and the decrease of PTA and serum Na in patients with HE hinted hinted a poor prognosis.5.The higher the HE stage and MELD score of HE patients,the worse the prognosis.When combined with the hepatorenal syndrome and upper gastrointestinal bleeding,the prognosis was poor.HE staging,MELD score,hepatorenal syndrome,and upper gastrointestinal bleeding were independent prognosis risk factors of HE.