Correlation between Frequency of Flaps in Asterixis and Severity of the Liver Disease in Patients with Hepatic Encephalopathy

Introduction: Frequency of flaps in asterixis is not uniform and varies among the patients. However, this flap frequency has not been given much importance in the literature. Neither it alters the grade of severity of Hepatic Encephalopathy (HE), nor has it been included in any of the scoring systems determining the severity of liver disease such as the Child Turcotte Pugh (CTP) and Model for End stage Liver Disease (MELD) scores. Aim: To study the correlation between frequency of flaps in asterixis and severity of the liver disease in patients with HE. Materials and Methods: Patients with decompensated cirrhosis and HE with asterixis had their flap frequency (per 30 seconds) counted at the time of their discharge, after clinical stabilisation. CTP and MELD scores were also calculated and the correlation between number of flaps and CTP and MELD scores was studied. A total of 63 such patients were followed up for a period of 12 months. We also studied whether patients with increasing number of flaps have a poorer clinical outcome, as suggested by re-hospitalisation. Results: The correlation between number of flaps and CTP score was non-significant (rs =0.02, p=0.87). Correlation between number of flaps and MELD score was also non-significant (rs =0.16, p=0.20). A 13% of patients with 15 flaps/30s. A total of 27 patients were re-hospitalised out of which 12 (44.4%) had worsening HE, 5 (18.5%) had Spontaneous Bacterial Peritonitis (SBP) and worsening HE, 6 (22.2%) had worsening ascites and 4 (14.8%) had acute kidney injury. Conclusion: There was no significant correlation between number of flaps and CTP and MELD scores. However, higher number of flaps was an independent predictor for rehospitalisation.