Outcomes of Hepatic Encephalopathy (HE) Grade Iv in Patients Admitted at Hospital

Abstract

Objective: To determine the frequency of outcomes of Hepatic Encephalopathy (HE) grade 4 in patients admitted at tertiary care hospital.

Methodology: This descriptive Cross-sectional study was conducted at department of Medicine of Indus medical college TM khan with collaboration of gastrointestinal department of Liaquat University of Medical and Health Sciences, Hyderabad, from May 2025 to November 2025. All the patients with grade-IV hepatic encephalopathy aged 18 t0 60 years and both genders were included. Following the complete medical history, clinical examination and medical record review patients were closely assessed during study period for the presence of recognized advancing factors and outcomes, specifically infection, gastrointestinal bleeding, electrolyte imbalance, constipation, acute kidney injury or multi organ failure, ICU admission and mortality. All the collected data were entered and analyzed using SPSS version 22.

Results: Of the 116 patients, 64.7% were male and 35.3% were female, with median age of 51.0 years. Hepatitis C was a leading etiology of liver disease (64.7%). The infection was nearly in half of the cases 48.3%, followed GI bleeding history (32.8%), mechanical ventilation need (32.8%), electrolyte imbalance (37.1%) and renal impairment around (36.2%), along with constipation in roughly 3 in 10 patients and multi-organ failure in around 1 in 5 (19.8%) cases. Overall, mortality rate was 39.7%, which significantly linked to advanced age, male gender and above all identified complications (p< 0.05).

Conclusion: The HE (Grade IV) represents a critical, high-mortality stage of hepatic failure, primarily influenced by identifiable and manageable complications, observed as outcomes, emphasizing the importance of their timely diagnosis and aggressive management to improve the outcomes of patients.