الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Poor outcomes are common among individuals who have decompensated cirrhosis and who develop extra hepatic organ system failure, denying ICU support should not be decided arbitrarily (Feltracco et al.,2011).Unfortunately, there are no criteria to predict whether cirrhotic patients who develop organ dysfunction will improve, or whether they will become refractory to interventions. An aggressive, prompt treatment of failure of a single organ and of some potentially reversible complications may result in satisfactory survival rates (Feltracco et al.,2011). Acute deterioration of chronic liver disease represents a critical situation that often cannot be treated on a medical ward because of the worsening of patient conditions and possible development of life- threatening complications requiring ICU management (Feltracco et al.,2011). This study was carried out on 200 cirrhotic patients with HE admitted to ICU of National Liver Institute Hospital, Menofyia University during the study period which extended from May 2013 to June 2014. The aim of this work was to assess the associated clinical and biochemical variables that could predict the outcomes in Egyptian patients with hepatic encephalopathy. All enrolled patients were subjected to the following: ???? 1-Complete clinical examination including Blood pressure, Pulse, respiratory rate and O2 saturation. 2-Base line investigation including: Urine analysis, Chest x-rays. Complete blood picture. 3- Liver Function Tests including; Serum bilirubin (total and direct), total protein, serum albumin, transaminases (AST, ALT), Serum alkaline phosphatase, Gamma glutamyltranspeptidase and Prothrombin time and International normalized ratio (INR). 4-Renal panel tests including: Blood urea, Serum creatinin and Serum electrolytes (sodium, potassium). 5-Other investigations to assess the etiology of liver disease including: Viral markers: HBs Ag, HCV Ab, autoimmune markers (ANA, ASMA) and metabolic liver profiles (Serum Fe, Cu and ceruloplasmin) 6- Fasting serum ammonia level. 7-Arterial blood gases (ABG). 8-Random blood sugar (RBS) 9-Cytology for ascetic fluid analysis to assess: Polymorph nuclear-cell count (PMNC).and complete aseptic Bed-Side Culture and sensitivity using blood culture Technique was done using Hi Media Blood Culturing System. 10- Abdominal ultrasonography. 11- Upper GIT endoscopy for bleeder cases. 2- Brain C.T in doubtful cases. 13- Applied scoring system to assess the status of liver reserve like: A-Child ?Pugh’s Turcotte score (CPT) B- Model for End-Stage Liver Disease (MELD) In addition to hemodynamic and fluid chart monitoring. While patients with the following criteria were excluded from the study: o Severe primary cardiopulmonary failure. o Intrinsic renal disease. o Basal serum creatinine of more than 4 mg/dL. o Hepatoma or other malignances. o Obstructive jaundice. Our results revealed the following: ? Among our studied cohorts, there was a high death rate in comparable with similar studies; 181 patients were died and 19 patients were recovered; so the mortality rate in our patients was 90.5%. ? Different grades of hepatic Encephalopathy were not a predictor for outcome in our cohorts. Higher grades were associated with high mortality; also lower grades were critical despite optimal anti coma measure given. HCV was the main leading cause of our CLD cases which reflect the disease burden affecting our country ? Gastrointestinal bleeding was the main Precipitating factors of HE which was detected in 87(43.5%) cases while other precipitating factors were found in 113(56.5%) cases. Upper GI bleeding can be a life-threatening consequence of portal hypertension in patients with liver cirrhosis. Mortality due to severe hemorrhagic complications accounts for more than 25% of the overall mortality among cirrhotic patients. Failure to control the hemorrhage or early rebreeding occurs in as many as 50% of patients in the first days to 6 weeks after the initial episode. ? As regard occurrence of hemodynamic instability, there were about 88 with hemodynamic instability among our studied cohort (about 84(95.4%) were died and 4 patients (4.6%) were survived while112 patients were stable. Hemodynamic status was showing statistically significant difference in both groups (P< 0.05). ? HTN was detected in thirty patients, twenty- four of them died (80%) and six recovered (20%). It can be considered as a significant predictor for patient’s outcome in our cohorts (P< 0.05). ? Septicemia was detected in 122 (60.5%) patients, 115 of them died (94.2%) it was considered as important confounding factor affecting outcome (P< 0.05). Presence of SBP was seen in 153(76.5%) cases, 142 of them died (92.8%) and 11 recovered (7.2%). It was one of the leading causes of mortality among our patients. ? As regard Child Pugh Score, it failed to predict the outcome in our patients while MELD score could predict the outcome. ? Both low systolic and low diastolic blood pressure values were predicting the patient’s mortality, while high pulse rates were among patients who died. ? High WBCs was predicting mortality as reflection for infection and predicting end organ damage with septicemia (P< 0.01). ? The mean values of serum creatinine and blood urea were significantly higher among died patients (P< 0.01), the inclusion of the creatinine in the MELD score reflects the importance of renal failure as a key determinant of mortality in patients with cirrhosis. ? So advanced liver disease, high blood pressure or hypotension, positive Septic screen (body fluids culture), advanced MELD score, high WBCs and high serum creatinine were independent predictors of outcome of our patients (p< 0.05).