A Clinical Study of Hepatic Encephalopathy in Chronic Liver Disease With Reference to Serum Ammonia in a Tertiary Care Hospital of North East India

Abstract

INTRODUCTION Hepatic encephalopathy is the term used to describe the complex, sometimes irreversible, and variable changes in neuropsychiatric status that can complicate both acute and chronic liver disease. A spectrum of neuropsychiatric abnormalities exists ranging from clinically indiscernible changes in cognition to clinically obvious changes in intellect behaviour, motor function, and consciousness. METHODS We conducted a hospital-based observational descriptive study comprising of 80 patients of chronic liver disease from June 2014-May 2015 who had been diagnosed on the basis of a thorough history, physical examination, including mini-mental status examination, Glasgow Coma Score, biochemical tests including arterial ammonia, radiological findings, EEG and CFF (critical flicker frequency) Tests after excluding other causes of neurological impairment. The patients were admitted in Gauhati Medical College and Hospital, Guwahati, Assam (India) and fulfilled the inclusion and exclusion criteria of the study. Statistical analysis was performed using one way ANOVA method of analysis. RESULTS In our study, 61 patients were male and 19 patients were female. 30% patients were in the third decade of life followed by 26.25% in the fourth decade and 18.75% in the fifth decade. Most of the patients were in Child-Pugh Class C (72.5%) followed by Class A (16.25%) and Class B (11.25%). The patients were assigned grades of hepatic encephalopathy according to the West-Haven classification. Majority of patients were in grade I hepatic encephalopathy (30%) followed by grade III (28.75%) and grade IV (21.25%). The lowest mean arterial ammonia level was found in grade 0 and grade I hepatic encephalopathy-39.2±7.4 mg/dL and 58.7±9.8 mg/dL (mean±standard deviation) respectively and the highest values were found in the highest grades of hepatic encephalopathy-grade III and IV (98.4±10.7 mg/dL and 145.0±17.0 mg/dL respectively). CONCLUSION The arterial ammonia correlates with the grades of hepatic encephalopathy and interventions aimed at reducing the ammonia level improves the outcome and prognosis.