Predictors of mortality in hepatic encephalopathy in acute and chronic liver disease: a preliminary observation.
BACKGROUND
Several scoring systems are available to predict the outcome of liver cell failure. Scarce information is available on predictors in hepatic encephalopathy.


OBJECTIVE
To study clinical and biochemical variables that would predict the outcome in hepatic encephalopathy.


METHODS
Fifty consecutive patients with hepatic encephalopathy were included in the study. Variables included clinical and biochemical parameters, discriminant function, QTc interval and the need for ventilator support. Child-Pugh's Turcotte score and Mayo Clinic model for end-stage liver disease scores were calculated at admission. Patients were followed up until discharge or death. Logistic regression analysis was computed with the variables that predicted a favorable outcome.


RESULTS
Chronic liver disease precipitated hepatic encephalopathy in 39 patients (group 1) and encephalopathy followed acute liver disease in 11 patients (group 2). In group 1, high serum bilirubin (P<0.001), prolonged QTc interval (P<0.05) and requirement for support systems (P<0.003) predicted a poor outcome. In group 2, higher grades of encephalopathy (P<0.04) and native drug therapy (P<0.007), high serum bilirubin (P<0.05), requirement for support systems (P<0.02) predicted a poor outcome. Mayo Clinic model for end-stage liver disease and discriminant function in both groups and Child-Pugh-Turcotte's score in group 1 did not predict the outcome. Logistic regression identified serum bilirubin in group 1 (OR 8.55, P=0.012) and native drug therapy in group 2 (odds ratio 3.85, P=0.05) as independent poor risk factors.


CONCLUSIONS
High serum bilirubin values in chronic liver disease and native drug therapy in acute liver cell failure are simple parameters that would predict a poor outcome in patients with hepatic encephalopathy.
Udayakumar
N
N
Institute of Internal Medicine, Madras Medical College, Chennai, Tamilnadu, India. udhaykumar81@yahoo.co.in
Subramaniam
K
K
Umashankar
L
L
Verghese
Joy
J
Jayanthi
V
V
D000208:Acute Disease; D000328:Adult; D001663:Bilirubin / Q000097:blood; D002908:Chronic Disease; D005260:Female; D006501:Hepatic Encephalopathy / Q000097:blood / Q000401:mortality* / Q000473:pathology; D017052:Hospital Mortality; D006801:Humans; D007194:India / Q000453:epidemiology; D008107:Liver Diseases / Q000097:blood / Q000150:complications* / Q000401:mortality / Q000473:pathology; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D016019:Survival Analysis
D001663:Bilirubin