Incidence of Hepatic Encephalopathy in Patients with Spontaneous Bacterial Peritonitis Using Rifaximin and Lactulose: A Study at a Tertiary Care Hospital in Rawalpindi

Abstract

Objective: To determine the incidence of hepatic encephalopathy (HE) in cirrhosis patients with spontaneous
bacterial peritonitis receiving Lactulose, Rifaximin, or a combination of both, and to compare the efficacy of
these treatments.
Study Design: Cross-sectional study.
Place and Duration of Study: The study was conducted at the Department of Medicine, Pak Emirates Military
Hospital Rawalpindi, Pakistan, from September 2021 to August 2022.
Methods: Using consecutive sampling, diagnosed cases of decompensated Chronic Liver Disease with clinically
apparent ascites, visiting the outpatient department, with or without signs and symptoms of spontaneous
bacterial peritonitis (SBP) were included in the study after laboratory confirmation of spontaneous bacterial
peritonitis. The drug history was taken, and hepatic encephalopathy was diagnosed using Mini-mental Scale
Examination and West-Haven criteria. The incidence of hepatic encephalopathy was compared across the
groups using the Pearson Chi-square test.
Results: A total of 60 diagnosed Chronic liver disease patients with spontaneous bacterial peritonitis were
included in the study. Rifaximin was being used by 41.7% (n=25), 41.7% (n=25) patients were using lactulose
alone and 16.7% (n=10) were using a combination of both drugs. 58.3% (n=35) of patients were found to have
hepatic encephalopathy. Out of these, 42.8% (n=15) were using rifaximin alone, 54.2% (n=19) were using
lactulose alone, while just 2% (n=1) patients were using the combination of both drugs (P < 0.001).
Conclusion: Spontaneous Bacterial Peritonitis is an important trigger of hepatic encephalopathy in the setting
of decompensated chronic liver disease and is associated with high mortality. The use of lactulose and rifaximin
combination is superior to monotherapy with either of them for preventing hepatic encephalopathy in these
patients.