Page 18 - Time to DeLiver: Getting a Grip on HE report 2015

SECTION 4

Delays in identifying patients with Hepatic
Encephalopathy: Impact on patient outcomes

• Hepatic encephalopathy is characterised The correct diagnosis of

by relatively non-specific signs and Hepatic Encephalopathy
symptoms such as personality changes,
sleep disorders, confusion, depression, is essential
slurred speech, lethargy, trembling hands,
poor co-ordination and bad breath. These Hepatic encephalopathy is associated with a
symptoms are often subtle and easily poor prognosis, and significant morbidity and
missed, meaning that the condition is mortality (between 50% and 64% of patients
generally under-diagnosed. There are also die within one year of diagnosis), which may be
other causes of similar symptoms that may improved with more effective treatment.20,25,26
present in patients with advanced chronic In addition, a prior episode of hepatic
liver disease.1,11,14 encephalopathy is associated with an increased
risk of subsequent episodes.2,26 In one study,
• In addition to feelings of isolation and stigma around half of patients with at least one prior
hepatic encephalopathy episode suffered
that can result in patients not seeking health recurrence within one year, despite being
or social support services, patients may also treated with lactulose.27 In another study, 46%
experience barriers to receiving a diagnosis. of those patients with at least two prior episodes
(most of whom were taking lactulose) suffered
• Healthcare providers who are not specialists recurrence within six months.28 Given these
data it is perhaps not surprising that patients
in liver disease may only infrequently are frequently readmitted for repeat hepatic
encounter patients with advanced chronic encephalopathy episodes.21,27,28
liver disease or hepatic encephalopathy, and
may not identify hepatic encephalopathy as Adequate diagnosis and treatment of hepatic
a possible cause of symptoms. encephalopathy can improve outcomes by
maintaining remission and reducing the risk
• A number of techniques and tests are used of hospitalisation.28

to diagnose hepatic encephalopathy, many
of which require expertise in administration
or interpretation.1,14,15 However, there is a
lack of an agreed standard diagnostic test
or procedure.14

Hepatic
encephalopathy
is associated with
significant morbidity
and mortality20,25,26

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