Prospective observational study on systemic inflammation and prognostic significance of hepatic encephalopathy

Hepatic encephalopathy (HE) is a common decompensating event in liver cirrhosis, with a prevalence of 10-14% in newly diagnosed cirrhotic and 30-40% during the course of the disease. The study aimed to evaluate the clinical spectrum, systemic inflammation, treatment outcomes, prognostic significance, and survival probability of HE in patients with liver cirrhosis. Over five years, consecutive patients hospitalized with HE were evaluated for symptoms, signs, etiology, inflammatory markers, prognostic index, and response to treatment. Primary outcomes included reversal of HE up to 10 days of admission and mortality at 28 days. Secondary outcomes included length of hospital stay, time taken for resolution of HE, adverse events, and recurrence of HE over 28 days. 539 patients were included. The median (range) age was 46 (18-82) years, with 84.4% males. Hyponatremia (65.4%) was the most common precipitating factor. Complete reversal of HE occurred in 62.8%. Median (range) Mean hospital stay was 7(27) days, and 28-day mortality during the study period was 26.1%. The survival probability was higher in grade 2 HE than in grade 3 and grade 4 (79.79 vs. 74.31 vs. 60.22%, p = 0.0020). Patients with resolution of HE had better survival {HR 0.271 [95% C. I (0.187-0.394)], p < 0.005}. Arterial ammonia, serum IL-6, and albumin were independent prognostic factors. Patients were classified into two groups according to a prognostic index calculated from these three variables. Survival probability at 28 days was 80.67% vs. 67% (p = 0.0001), respectively, in patients with low prognostic and high prognostic indexes. Approximately one-third of patients with liver cirrhosis with acute episodes of HE have non-reversal of HE and poor survival. The development of HE and its resolution is a crucial prognostic event in liver cirrhosis patients. The prognostic significance of hepatic encephalopathy has been previously studied in unison or combination with other decompensating events. However, data on the prognostic role of systemic inflammatory markers in patients with hepatic encephalopathy have not been well evaluated. This prospective observational study assessed the systemic inflammation, short-term prognostic significance, and survival probability of patients with hepatic encephalopathy (HE) with liver cirrhosis over 5 years. This study identified a prognostic index that could stratify patients with hepatic encephalopathy into those with a high or low survival risk. The development of HE and its resolution is a crucial prognostic event in liver cirrhosis patients. These early stratifications can help in identifying patients with a high risk of death, and advanced treatment or early transplantation can be advised.