Risk factors of hepatic encephalopathy after an episode of upper gastrointestinal bleeding in patients with liver cirrhosis

A LLancho Muñoz

Virgen de las Nieves University Hospital. Granada.

EJ Ortega Suazo

Virgen de las Nieves University Hospital. Granada.

JM López Tobaruela

Virgen de las Nieves University Hospital. Granada.

C Tendero Peinado

Virgen de las Nieves University Hospital. Granada.

M López Vico

Virgen de las Nieves University Hospital. Granada.

R Fernández García

Virgen de las Nieves University Hospital. Granada.

JG Martínez Cara

Virgen de las Nieves University Hospital. Granada.

E Redondo Cerezo

Virgen de las Nieves University Hospital. Granada.

R Jiménez Rosales

Virgen de las Nieves University Hospital. Granada.

Abstract

Introduction: Hepatic encephalopathy (HE) is defined as a set of potentially reversible neuropsychiatric alterations secondary to hepatocellular failure and/or portosystemic shunting, being a frequent complication in the evolution of liver cirrhosis. One of the triggers of HE is upper gastrointestinal bleeding (UGB); however, there are few studies that analyse the predisposing factors for the development of HD in this clinical context, as well as its impact on patient prognosis.

Objective: To compare the clinical and blood test characteristics of the group of patients with UGB who develop HE with those who do not, identifying predisposing factors; and to analyse the prognosis of the patients with respect to the group to which they belong.

Methods: Retrospective analysis of a prospective registry including all patients with UGB treated at the Hospital Universitario Virgen de las Nieves between 2013 and 2021, who underwent urgent gastroscopy and presented clinical and/or radiological data of liver cirrhosis. Clinical, biochemical and evolution data (during admission and deferred) were obtained.

Results: Of the 258 patients with liver cirrhosis admitted for UGB, 66 developed HE. Of the variables analysed, only ascites, albumin and urea on admission were found to be independent factors in the development of HE. Furthermore, it was found that the development of HE only significantly increased in-hospital mortality.

Conclusions: The development of HE during an admission for UGB is associated with an increased risk of in-hospital mortality, with liver function variables and urea on admission being the only parameters independently related to the development of HE, with no significant patient-intrinsic data or variables regarding the type of bleeding.

Keywords: liver cirrhosis, hepatic encephalopathy, upper gastrointestinal bleeding.