PREDICTORS OF OUTCOME IN HEPATIC ENCEPHALOPATHY: ROLE OF SERUM AMMONIA AND CHESS SCORE

Abstract

Background

Hepatic encephalopathy (HE) is a reversible neuropsychiatric complication of liver dysfunction, occurring in 30–45% of cirrhotic patients. Minimal HE may affect up to 60%. While ammonia is implicated in its pathogenesis, its role in predicting outcomes remains unclear. CHESS (Clinical Hepatic Encephalopathy Staging Scale) is a newer, simpler tool to assess HE severity. This study evaluates serum ammonia and CHESS score at admission as predictors of outcome in HE.

Methods

Fifty patients with HE (Hepatic Encephalopathy) due to chronic liver disease were studied. Serum ammonia and CHESS scores were recorded at admission. Patients were followed until discharge or death. LOS (Length of hospital Stay) was calculated for survivors.

Results

Among 50 patients (46 males, 4 females; mean age 52 years), 14 died. Mean ammonia levels in survivors and non-survivors were 111.4 µmol/L and 122.9 µmol/L, respectively (not statistically significant). However, among survivors, higher ammonia levels significantly correlated with longer LOS (p=0.049). Survivors with LOS >5 days had a mean ammonia level of 123.44 µmol/L, while those with LOS ≤5 days had 75.22 µmol/L. CHESS score <3 was seen in 6 patients (1 death); CHESS >3 in 44 patients (13 deaths). CHESS score did not significantly correlate with mortality or ammonia levels.

Conclusion

Serum ammonia at admission correlates with length of hospital stay among survivors. Ammonia levels did not predict mortality or correlate with CHESS score. The CHESS score failed to predict HE outcomes.