Alcoholism and Socioeconomic Status among Patients with Hepatic Encephalopathy in Association with Increased Mortality

Document Type : Original Article


Multidisciplinary Center for Biomedical Research, Aarupadai Veedu Medical College and Hospital, Vinayaka Mission’s Research Foundation (Deemed to be University), Kirumampakkam, Puducherry-607402, India



Background: Hepatic encephalopathy (HE) is a complex neuropsychiatric disorder indicated by a deterioration in the functioning of hepatocytes. Impaired brain function is observed in advanced alcoholic liver disease particularly manifesting as HE. The pathophysiology of alcohol-related HE remains unclear. Accordingly, this study aimed to assess alcoholism and socioeconomic status of patients with liver disease compared with stages of HE.
Methods: This cross-sectional study was conducted on 62 alcoholic patients who have been consuming alcohol for more than 14 years. Patients were recruited based on the assessment of clinical symptoms and diagnosed according to the MELD and Child-Pugh scoring systems.
Findings: Descriptive statistics including demographic details and clinical features of patients were classified based on alcoholism and socioeconomic status. Patients belonging to the lower- and middle-income classes were more in number with a mean age of 46.66±10.21 and 47.14±6.36 years, respectively compared to upper-middle- and upper-income classes. The amount of alcohol intake was 116.59±45.60 in the middle class and 110.0±62.45 in the upper class. 
Conclusion: Increased progression of HE leads to a rise in the mortality rate due to higher consumption of alcohol. HE is a severe complication in alcohol-related liver cirrhosis that contributes to impaired cognitive function in patients. 


Prabhudas Nelaturi: (Google Scholar) (PubMed)

Sangeetha P Kademani: (Google Scholar) (PubMed)

Ravikumar Sambandam: (Google Scholar) (PubMed)


1. Ferenci P. Hepatic encephalopathy. Gastroenterol Rep (Oxf). 
2017;5(2):138-47. doi: 10.1093/gastro/gox013.
2. Butterworth RF. Hepatic encephalopathy in alcoholic 
cirrhosis. Handb Clin Neurol. 2014;125:589-602. doi: 
3. Aldridge DR, Tranah EJ, Shawcross DL. Pathogenesis of 
hepatic encephalopathy: role of ammonia and systemic 
inflammation. J Clin Exp Hepatol. 2015;5(Suppl 1):S7-20. doi: 
4. Rose CF, Amodio P, Bajaj JS, Dhiman RK, Montagnese 
S, Taylor-Robinson SD, et al. Hepatic encephalopathy: 
novel insights into classification, pathophysiology and 
therapy. J Hepatol. 2020;73(6):1526-47. doi: 10.1016/j.
5. Swaminathan M, Ellul MA, Cross TJ. Hepatic encephalopathy: 
current challenges and future prospects. Hepat Med. 
2018;10:1-11. doi: 10.2147/hmer.s118964.
6. Suraweera D, Sundaram V, Saab S. Evaluation and 
management of hepatic encephalopathy: current status and 
future directions. Gut Liver. 2016;10(4):509-19. doi: 10.5009/
7. Elwir S, Rahimi RS. Hepatic encephalopathy: an update on 
the pathophysiology and therapeutic options. J Clin Transl 
Hepatol. 2017;5(2):142-51. doi: 10.14218/jcth.2016.00069.
8. Wijdicks EF. Hepatic encephalopathy. N Engl J Med. 
2016;375(17):1660-70. doi: 10.1056/NEJMra1600561.
9. Askgaard G, Fleming KM, Crooks C, Kraglund F, Jensen CB, 
West J, et al. Socioeconomic inequalities in the incidence 
of alcohol-related liver disease: a nationwide Danish study. 
Lancet Reg Health Eur. 2021;8:100172. doi: 10.1016/j.
10. Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen 
KD, et al. Hepatic encephalopathy in chronic liver disease: 
2014 Practice Guideline by the American Association for 
the Study of Liver Diseases and the European Association for 
the Study of the Liver. Hepatology. 2014;60(2):715-35. doi: 
11. Knott CS, Coombs N, Stamatakis E, Biddulph JP. All cause 
mortality and the case for age specific alcohol consumption 
guidelines: pooled analyses of up to 10 population-based 
cohorts. BMJ. 2015;350:h384. doi: 10.1136/bmj.h384.
12. Kunzmann AT, Coleman HG, Huang WY, Berndt SI. The 
association of lifetime alcohol use with mortality and 
cancer risk in older adults: a cohort study. PLoS Med. 
2018;15(6):e1002585. doi: 10.1371/journal.pmed.1002585.
13. Mann RE, Smart RG, Govoni R. The epidemiology of alcoholic 
liver disease. Alcohol Res Health. 2003;27(3):209-19.
14. Tapper EB, Parikh ND. Mortality due to cirrhosis and liver 
cancer in the United States, 1999-2016: observational study. 
BMJ. 2018;362:k2817. doi: 10.1136/bmj.k2817.
15. Khan A, Ayub M, Khan WM. Hyperammonemia is associated 
with increasing severity of both liver cirrhosis and hepatic 
encephalopathy. Int J Hepatol. 2016;2016:6741754. doi: