Amit Bagrodia, Venkatesh Vaithiyam, Lalit C Kummetha, Nikhil Sirohi, Barjesh C Sharma, Siddharth Srivastava, Sanjeev Sachdeva, Ajay Kumar, Ashok Dalal, Ujjwal Sonika, Mahima Kapoor
Among patients with liver cirrhosis presenting with index AMS, HE was the most common etiology, and non-HE causes of AMS were present in nearly half of the presentations. Sepsis and metabolic abnormalities predominated among patients with non-HE causes. Mortality was numerically higher in HE patients and was highest in those with brain structural lesions. Routine NCCT head imaging has low diagnostic yield in patients with AMS without focal neurological deficits.
BACKGROUND/AIMS: Altered mental status (AMS) is common in patients with cirrhosis. While hepatic encephalopathy (HE) is the most frequent cause, nonhepatic causes such as sepsis, metabolic disturbances, brain lesions, and toxin, may coexist and affect outcomes. This study evaluated the causes and role of noncontrast computed tomography (NCCT) head in patients with cirrhosis and AMS and mortality.
METHODS: In this prospective study, 116 cirrhotic patients with index AMS were enrolled over 18 months. The etiologies were categorized as hepatic, infectious, metabolic, structural lesions of the brain, toxic, or multifactorial based on clinical evaluation, laboratory investigations, and NCCT of the head. The diagnostic yield of NCCT of the head was evaluated in all patients with AMS. Mortality was assessed during hospitalization and at 30 and 90 days.
RESULTS: HE accounted for 54.3% of AMS, while nonhepatic causes accounted for 45.7%; sepsis (20.7%) and metabolic abnormalities (14.7%) were the predominant nonhepatic causes, followed by structural brain lesions (5.2%), toxins (1.7%), and multifactorial etiologies (3.5%). Six patients had focal neurological deficits with structural brain lesions on NCCT head scans; NCCT did not show any acute clinically relevant intracranial pathologies in all patients without focal deficits or structural lesions. Overall mortality in the study population was 29.31%, 33.33% with HE, and 24.53% among those with other causes of AMS.
CONCLUSION: Among patients with liver cirrhosis presenting with index AMS, HE was the most common etiology, and non-HE causes of AMS were present in nearly half of the presentations. Sepsis and metabolic abnormalities predominated among patients with non-HE causes. Mortality was numerically higher in HE patients and was highest in those with brain structural lesions. Routine NCCT head imaging has low diagnostic yield in patients with AMS without focal neurological deficits.
CLINICAL TRIAL REGISTRY OF INDIA: CTRI/2025/05/087896.