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. 2022 Aug 31:42:323.
doi: 10.11604/pamj.2022.42.323.30089. eCollection 2022.

[Predictors of hepatic encephalopathy in patients with severe acute liver injury]

[Article in French]
Amal Khsiba  1 , Samir Bradai  1 , Moufida Mahmoudi  1 , Asma Ben Mohamed  1 , Mouna Medhioub  1 , Lamine Hamzaoui  1 , Mohamed Mousadek Azouz  1
Affiliations

[Predictors of hepatic encephalopathy in patients with severe acute liver injury]

[Article in French]
Amal Khsiba et al. Pan Afr Med J. .

Abstract
in English, French

Introduction: severe acute liver injury (SALI) formerly known as severe acute hepatitis is an acute inflammation of the liver with markers of liver injury (elevated transaminases) and signs of hepatocellular failure (jaundice and INR greater than 1.5) according to the latest definition of the European Association for the Study of the Liver (EASL). An important prognostic factor in SALI is the development of hepatic encephalopathy (HE) and thus its progression to acute liver failure (ALF), formerly known as acute severe hepatitis. The purpose of this study is to investigate factors predicting the development of hepatic encephalopathy during SALI.

Methods: we conducted a retrospective study of patients treated for SALI between January 2000 and December 2019. We divided patients into two groups depending on whether hepatic encephalopathy occurred. We performed an analytical study comparing the two groups according to their epidemiological, biological and evolutionary data.

Results: data from the medical records of fifty-nine patients were collected. A virus was the most frequent cause (63%). Hepatic encephalopathy occurred in 15 patients (25.4%). Factors predicting the development of HE in univariate analysis were a delay in consultation of more than 9 days, an INR level of more than 2.45, a bilirubin level of more than 230 μmol/l, creatinine greater than 60.5 μmol/l, urea greater than 5.5 mmol/l and MELD score greater than 26.5 (p=0.023, p=0.017, p=0.0001, p=0.049, p=0.0001, p=0.0001 respectively). Autoimmune hepatitis and an undetermined cause were associated with the development of HE (p=0,003 and p=0,044, respectively). In multivariate analysis, autoimmune aetiology and a urea level above 5.5 mmol/l were significantly associated with the occurrence of HE. No statistically significant differences were found between the two groups with regard to age, sex and diabetes.

Conclusion: SALI is a rare disease, mainly due to a virus in our country. Predictive factors of HE are important for early identification of patients at risk of adverse outcomes.

Introduction: l´atteinte hépatique aiguë sévère (AHAS) est une inflammation aiguë du foie avec des perturbations des marqueurs d´atteinte hépatique et des signes d´insuffisance hépatocellulaire (ictère et INR supérieur à 1,5) selon définition de l´association européenne pour l'étude du foie.Le facteur qui conditionne le pronostic de l´AHAS reste l´apparition d´une encéphalopathie hépatique (EH). L´objectif de ce travail est de rechercher les facteurs prédictifs du développement de l´EH au cours de l´AHAS.

Méthodes: il s´agit d´une étude observationnelle rétrospective entre janvier 2000 et décembre 2019. Nous avons réalisé une étude analytique comparant les deux groupes en fonction de l´apparition ou non d´une EH.

Résultats: cinquante-neuf patients ont été colligés. La survenue d'une EH était observée chez 15 patients (25,4%). Les facteurs prédictifs de la survenue d´une EH en analyse univariée étaient un délai de consultation supérieur à 9 jours, un taux d´INR supérieur à 2,45, un taux de bilirubine supérieur à 230 μmol/l, créatininémie supérieur à 60,5 μmol/l, un taux d'urée supérieur à 5,5 mmol/l et un score MELD supérieur à 26,5 (p=0,023, p = 0,017, p = 0,0001, p=0,049, p = 0,0001, p = 0,0001 respectivement). L´hépatite auto-immune et la cause indéterminée étaient associées à l´apparition d´une EH (respectivement p=0,003 et p=0,044). En analyse multivariée, l´étiologie auto-immune et un taux d´urée supérieur à 5,5 mmol/l étaient significativement associés à la survenue d´une EH.

Conclusion: la survenue de l´EH est le résultat de l´interférence de plusieurs facteurs associant des paramètres biologiques comme l´INR, la bilirubinémie, la fonction rénale et l´étiologie en cause.

Keywords: Severe acute liver injury; acute liver failure; hepatic encephalopathy; prognosis.

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Conflict of interest statement

Les auteurs ne déclarent aucun conflit d'intérêts.

Figures

Figure 1
Figure 1
courbe ROC du délai de la consultation pour l´évaluation du risque de l´encéphalopathie hépatique
Figure 2
Figure 2
courbe ROC du score MELD pour l´évaluation du risque de l´encéphalopathie hépatique
See this image and copyright information in PMC

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