Precipitating factors and the outcome of hepatic encephalopathy in liver cirrhosis

To determine precipitants of hepatic encephalopathy [HE] and their impact on hospital stay and mortality. Cross-sectional, analytical study. The Aga Khan University Hospital, from January 2005 to December 2007. Consecutive patients admitted with different grades of HE were evaluated between January 2005 and December 2007. The precipitants of HE were correlated with the different grades of HE, and length of hospital stay and mortality. Chi-square test was used to compare the proportion of precipitating factors versus hospital stay and grade with significance at p < 0.05. Of the 404 patients 252 [62%] were males. Hepatitis C virus was the cause of cirrhosis in 283 [70%]; Child Turcotte Pugh [CTP] class C was present in 317 [78%] patients. On presentation, 17% patients had grade 1 HE while 44%, 29% and 10% had grades 2, 3 and 4 respectively. The most common precipitant of HE was spontaneous bacterial peritonitis in 83 [20.5%], constipation in 74 [18.3%] and urinary tract infection in 62 [15.3%]. One hundred and forty [35%] patients had >/= 2 precipitating factors while no precipitant was noted in 50 [12%] patients. Mean hospital stay was 4 +/- 3 days. The lesser the number of precipitants, shorter was the length of stay [p < 0.01] and lesser was the grade of HE [p=0.025]. Complete reversal of HE was noted in 366 patients [91%] while the remaining had grade 1 HE on discharge. Nine [2.2%] patients died during the hospital stay. No mortality was noted in patients without precipitants. Patients presenting with >/= 2 precipitating factors and advanced grade of HE had a prolonged hospital stay. Moreover, patients without precipitants had better outcomes

Frequency and characteristic features of portal hypertensive gastropathy in patients with viral cirrhosis

To determine the frequency and specific characteristic features of portal hypertensive gastropathy [PHG] in cirrhosis due to viral etiology. Cross-sectional descriptive study. The Aga Khan University Hospital, Karachi, from June 2006 till June 2008. Patients with hepatitis B and C cirrhosis were included who underwent screening esophago-gastro-duodenoscopy [EGD] for varices. Baveno III consensus statement was used for diagnosing PHG on endoscopy and divided them into two subgroups i.e. mild and severe. Data related to platelet/spleen ratio, MELD score and Child Turcotte Pugh [CTP] score indicating severity of cirrhosis were recorded in all patients. Findings were compared by using independent sample t-test. Out of 360 patients who underwent screening EGD, 226 [62.8%] were males. Two hundred and eighty one [78%] had hepatitis C while 79 [22%] suffered from hepatitis B related cirrhosis. Three hundred patients [83.3%] had PHG while 71 [24%] had severe PHG. Higher proportion of esophageal varices [89.7%] was present among those who had PHG [p < 0.001]. On univariate analysis lower platelet counts [117 +/- 55 vs. 167 +/- 90; p < 0.001], increased spleen size [14.1 +/- 2.9 cm vs. 12 +/- 2.4cm; p < 0.001] were found in PHG patients as compared to those without it. Similarly, lower platelet/spleen ratio was noted in patients with severe PHG [916 +/- 400 vs. 1477 +/- 899; p < 0.001]. Furthermore, on multivariate analysis CTP score > 8 MELD score > 12 and platelets/spleen ratio < 900 were significantly associated factors with severe PHG. Frequency of PHG was 83% while severe PHG was seen in 24% cases of viral hepatic cirrhosis. MELD score > 12, CTP score >/= 8 and platelets/spleen ratio