Clinical Profile and Predictors of Hepatic Encephalopathy in Liver Cirrhosis: A Cross-Sectional Study at Mardan Medical Complex, Mardan
Keywords:
Hepatic encephalopathy, Chronic liver disease, Risk Factors.Abstract
Background: A common and dangerous complication of liver cirrhosis, hepatic encephalopathy (HE) dramatically raises hospitalization, morbidity, and mortality. There is limited local data exist from LMICs. Among hospitalized patients with cirrhosis at Mardan Medical Complex, Mardan.
Objective: The goal is to ascertain the prevalence, grade distribution, precipitating events, and independent predictors of early HE (within 48 hours).
Methods: Between January and August of 2025, a prospective cross-sectional study was carried out. Adults who had cirrhosis and were consecutive were enrolled. At admission and 48 hours later, HE was evaluated using the West Haven criteria. Clinical and analytical parameters were collected, and precipitating factors were systematically screened. Using multivariable logistic regression with bootstrap validation, independent predictors were found. AUC and calibration measures were used to assess the model's performance, and a bedside nomogram was produced.
Results: 256 patients (mean age 54.3 ± 11.8 years; 59.8% male) were included out of 281 screened. 39.5% (95%CI 33.7–45.6) had HE, and 81.2% had Grade I–II. The most common precipitants were infection (36.6%) and hyponatremia (29.7%). Independent predictors included prior HE (AOR 2.41, 95% CI 1.34–4.33), infection (AOR 2.09, 1.28–3.43), lower sodium (per 3 mmol/L decrease: AOR 1.35, 1.16–1.57), higher creatinine (per 0.5 mg/dL increase: AOR 1.28, 1.04–1.58), higher bilirubin (per 1 mg/dL increase: AOR 1.06, 1.02–1.10), higher INR (per 0.5 increase: AOR 1.31, 1.06–1.62), constipation (AOR 1.68, 1.02–2.77), and exposure to psychoactive drugs (AOR 1.95, 1.06–3.57). Excessive diuretics showed borderline significance (AOR 1.72, 0.99–2.98; p = 0.054). The model demonstrated high calibration and strong discrimination (AUC 0.83).
Conclusion: Modifiable factors play a major role in the prevalence of early HE in cirrhosis. In environments with limited resources, the validated bedside nomogram may facilitate early triage and focused interventions.
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