THE IMPORTANCE OF BACTERIAL-INFECTIONS AS PRECIPITATING FACTORS OF CHRONIC HEPATIC-ENCEPHALOPATHY IN CIRRHOSIS

BACKGROUND/AIMS: It is generally accepted that chronic hepatic encepha lopathy (HE) is a stable form of neuropsychiatric disorder, usually re lated to porto-systemic shunts and with no exogenous precipitating fac tors. Bacterial infections are frequent causes of morbidity in cirrhos is, including the development of HE in its acute form, but there are n o reports of its role in chronic forms of HE. METHODOLOGY: We studied 168 episodes of hepatic encephalopathy in 111 patients with cirrhosis who were admitted to hospital during the last four years. Clinical sta ging was used for the diagnosis of acute and chronic HE, complemented by number connection tests and EEG. In chronic HE the diagnostic crite ria were intolerance to animal proteins and a continuous need for medi cations and/or special diets. Alcohol was the etiology of cirrhosis in 81.1% of patients, hepatitis B or C virus in 12.6% and various factor s in 6.3%. The male/female ratio was 3:1 and mean age was 53 years. RE SULTS: Twenty patients (18%) were characterized as having chronic HE, whereas ninety-one (82%) presented acute HE. Precipitating factors cou ld be detected in 43 out of 57 (75.4%) of chronic forms and in 108 of 111 (97.3%) episodes of acute HE. Bacterial infections were associated with HE in 15 of 43 cases (34.8%) of chronic HE and in 37 of 108 (34. 7%) cases of acute HE (p<0.05). Spontaneous bacterial peritonitis was the most prevalent infection in acute HE, whereas urinary tract infect ion was most frequent in chronic HE. Mortality was higher in acute tha n in chronic HE (p<0.001), associated with Child C prognostic classifi cation, grades III and IV of HE and more severe precipitating factors. CONCLUSIONS: The diagnosis and control of precipitating factors, espec ially bacterial infection, should also be considered during the treatm ent of chronic hepatic encephalopathy.