The progression of hepatic encephalopathy (HE) can determine outcome in acute liver failure (ALF).
In this study, researchers from the United States identified the predictive factors of worsening HE. They evaluated the relation of encephalopathy with the systemic inflammatory response (SIRS) and infection.
The team assessed 227 consecutive patients with stage I-II HE who were enrolled in the US Acute Liver Failure Study.
They used both univariate and multivariate analysis to evaluated 27 variables at admission.
|Infection preceded progression in 79% of the acetaminophen group.|
Analyses were performed separately for acetaminophen and non-acetaminophen etiologies.
The doctors found, using multivariate analysis, that infection during stage I-II HE, increased leukocyte levels at admission, and decreased platelet count were all predictive of worsening HE in the acetaminophen group.
However, increased pulse rate and AST levels at admission were the only predictive factors of worsening HE in the non-acetaminophen group.
In those patients who progressed to deep HE, the team found that the first confirmed infection preceded progression in 79% of the acetaminophen group versus 52% of the non-acetaminophen group.
In patients without positive microbiologic cultures, SIRS at admission was associated with worsening of HE.
Dr Javier Vaquero's team concluded, "This prospective evaluation points to infection and/or the resulting systemic inflammatory response as important factors contributing to worsening HE in ALF".
"The use of prophylactic antibiotics in these patients and the mechanisms by which infection triggers hepatic encephalopathy require further investigation".