Adherence to Practice Guidelines for the Initial Treatment of Overt Hepatic Encephalopathy among Patients with Liver Cirrhosis: A Descriptive Retrospective Study

Abstract Background: Nonadherence to guidelines is common in clinical practice and contributes to rising healthcare costs. Therefore, this study aimed to assess the adherence to the American Association for the Study of Liver Diseases and the European Association for the Study of Liver (AASLD/EASL) practice guidelines for the initial treatment of overt hepatic encephalopathy (OHE) in a tertiary Sudanese hospital. Methodology: A descriptive, retrospective, and hospital-based study was conducted in the hepatology department of Ibn Sina Specialty Hospital in Khartoum, Sudan. All patients with liver cirrhosis admitted to the hospital between January and December 2019 were included in this study. Data were collected from the patient’s medical files using a validated data collection form and then analyzed using the SPSS software. Results: Of 148 patients with liver cirrhosis, OHE was reported in 65 (43.9%). Males were the predominant group (81.5%). The mean age was 58.1 ± 12 standard deviation. A total of 33.8% of patients presented with Grade II HE. Infection was the main precipitating factor in 25.7% of the cases. Treatments for the precipitating factors were started for all patients after admission, and 95.3% started therapy to lower the blood ammonia level. Lactulose monotherapy was the first-line treatment in 30.8% of the cases. The starting dose of lactulose was 10–15 mL three times\day in 38.6% of the cases. Moreover, 83% of the patients were discharged with good outcomes. Good adherence to the guidelines was found regarding the identification and treatment of the precipitating factors. In only 32.3% of cases, lactulose monotherapy was the first-line therapy and none of the patients received the recommended initial dose of lactulose according to the AASLD/EASL guidelines, which indicated poor adherence. Conclusion: Despite inadequate adherence to the practice guidelines concerning lactulose monotherapy as the initial treatment and its starting dose, the vast majority of patients were discharged with the positive outcomes.