A Model for Predicting Development of Overt Hepatic Encephalopathy in Patients With Cirrhosis

Riggio, Oliviero; Amodio, Piero; Farcomeni, Alessio; Merli, Manuela; Nardelli, Silvia; Pasquale, Chiara; Pentassuglio, I.; Gioia, Stefania; Onori, Eugenia; Piazza, Nicole; Rui, Michele De; Schiff, Sami; Montagnese, Sara

doi:10.1016/j.cgh.2014.12.025

Cited by 52 publications

(63 citation statements)

References 36 publications

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“…Therefore, patients with resolved OHE may be at risk for developing MHE, regardless of the extent of any liver damage. Furthermore, MHE is a risk factor for OHE (9), and resolution of OHE is a risk factor for MHE, which highlights the importance of accurately determining whether patients with cirrhosis have a history of OHE. The present findings confirm this concept, as a history of OHE was the best predictor of MHE among all the variables that were evaluated.…”

Section: Discussionmentioning

confidence: 99%

“…Serum levels of nitrotyrosine (7) and inflammatory cytokines (8) may also be useful for diagnosing MHE, although these techniques are not commercially available in Japan. However, it is critical to diagnose MHE in patients with cirrhosis, as MHE is a risk factor for OHE (9), reduces the 5-year survival rate for cirrhosis (10), impairs the ability of an individual to drive a vehicle (11), increases the incidence of motor vehicle accidents (12,13) and increases the risk of falls (14). Furthermore, MHE is a highly prevalent cognitive disorder that severely affects the health-related quality of life for individuals (15 30.1% of cirrhotic patients in Japan (16).…”

Section: Introductionmentioning

confidence: 99%

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Screening for minimal hepatic encephalopathy in patients with cirrhosis by cirrhosis-related symptoms and a history of overt hepatic encephalopathy

et al. 2016

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Abstract. The diagnosis of minimal hepatic encephalopathy (MHE) is more difficult in comparison to the diagnosis of overt hepatic encephalopathy (OHE), as patients with MHE do not exhibit overt neurological deficits and must be diagnosed using specialized equipment. However, identifying MHE is critical for patients with cirrhosis, and a simple screening test is required. The present study aimed to evaluate the associations between MHE, clinical characteristics and questionnaire items regarding sleep disturbances and cirrhosis-related symptom score (CSS). A total of 91 patients who had cirrhosis without OHE were evaluated using various questionnaires [i.e., CSS, Epworth Sleepiness Scale, the Japanese version of the Pittsburgh Sleep Quality Index (PSQI) and the Japanese 36-item short-form health survey (SF-36)]. MHE was diagnosed using the neuropsychological test. MHE was associated with severe liver damage, which was indicated by liver damage markers and a history of OHE. In addition, MHE was associated with the CSS, PSQI and SF-36 results. The multivariate analyses revealed that a history of OHE was the factor that was the most strongly associated with MHE. Among patients without a history of OHE, MHE was most strongly associated with CSS, although it was also associated with severe liver damage and platelet counts. A prediction score (calculated using a history of OHE and CSS) provided an area under the receiver operating characteristic curve of 0.738 and a sensitivity of 0.671 for identifying MHE. In conclusion, a history of OHE and CSS may be useful for identifying MHE in patients with cirrhosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Screening for minimal hepatic encephalopathy in patients with cirrhosis by cirrhosis-related symptoms and a history of overt hepatic encephalopathy

et al. 2016

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“…All TIPS procedures were carried-out by the same radiology team, using PTFE-covered stents of 10 mm diameter as previously described. 22 The day before the procedure, a basal evaluation of HE, including an examination and grading of the patients' mental state, asterixis and psychometric performance 23 as well as the determination of venous blood ammonia were carried out as previously described. 24 None of the patients received any pharmacological treatment to prevent the occurrence of HE.…”

Section: Tips Placement Follow-up and He Evaluationmentioning

confidence: 99%

The modification of quantity and quality of muscle mass improves the cognitive impairment after TIPS

Gioia

Merli

Nardelli

et al. 2019

Liver International

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Background Hepatic encephalopathy (HE) is the major complication of transjugular intrahepatic portosystemic shunt (TIPS). In cirrhotic patients, a correlation between sarcopenia and HE has been suggested. Aim To evaluate the evolution of the skeletal muscle quantity and quality at CT scan and of the patients' cognitive impairment (both overt and minimal HE) before and after TIPS. Patients and Methods Twenty‐seven cirrhotic patients submitted to TIPS were studied. The modification of Skeletal Muscle Index (SMI), muscle attenuation, HE and plasma ammonia were evaluated before and after a mean follow‐up of 9.8 ± 4 months after TIPS. Results During the follow‐up, the mean SMI and muscle attenuation increased significantly, although not uniformly in all patients. Psychometric Hepatic Encephalopathy Score (PHES) and ammonia improved significantly in the patients with amelioration in SMI >10% (n = 16) and not in those without (n = 11) (PHES: −1.6 ± 2 vs −4.8 ± 2.1; P = 0.0005; ammonia: 48.5 ± 28.7 vs 96 ± 31.5 μg/dL; P = 0.0004). Moreover, the prevalence of minimal HE (12.5% vs 73%, P = 0.001) as well as the number of episodes of overt HE during the follow‐up were significantly reduced in the patients with improved SMI. Model for end‐stage liver disease remained stable or worsened after TIPS and was not significantly different between the groups with or without SMI improvement. Conclusion The amelioration of muscle wasting and HE independent of liver function observed after TIPS supports the causal relationship between muscle wasting and HE.

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“…However, we should have simple and low‐cost strategies to screen cirrhotic patients at risk for HE. One example is the model proposed by Riggio et al, who developed and validated a risk score to identify patients with cirrhosis at 1‐year risk for overt HE based on previous HE and albumin levels . Tapper et al developed a score to stratify the HE risk according to the presence of some clinical variables (laboratory tests and drugs), such as bilirubin, albumin as well as statins and non‐selective betablockers use .…”

Section: Discussionmentioning

confidence: 99%

Oral glutamine challenge is a marker of altered ammonia metabolism and predicts the risk of hepatic encephalopathy

Ampuero

Gil

Viloria

et al. 2019

Liver International

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Background The current therapies for hepatic encephalopathy (HE) are not completely effective in all patients, probably due to the physiopathological heterogeneity and the different conditions underlying the bout of HE. We hypothesized that oral glutamine challenge (OGC) is able to predict the risk of HE through the identification of various features and types of HE. Methods We included 238 cirrhotic patients (198 without and 40 with a previous HE episode) that underwent OGC, obtaining baseline and 60 minutes post‐load ammonia levels. Combined evaluation of baseline hyperammonemia (>78 mcg/dL) and impaired OGC (Δ >32 mcg/dL) defined low‐, intermediate‐ and high‐risk groups. Patients were censored at HE, liver transplantation and death or 6 years of follow‐up. Results The 28.3% (56/198) of the main cohort suffered from HE during the follow‐up. In the competing risk analysis, both intermediate‐ (subhazard ratio (sHR) 2.01 (95% CI 1.00‐4.14); P = .048) and high‐risk groups (sHR 4.67 (95% CI 2.19‐9.98); P = .0001) were associated with the first HE episode, together with age and albumin. Similar results were found for repeated HE events. The cumulative incidence for HE of the high‐risk group was two and four times greater than the intermediate‐ and low‐risk groups, respectively. The HE grade was also higher in individuals with the greatest risk (P = .035). The most common precipitant factor was diuretics in the high‐risk group, while infections and electrolyte imbalance predominated in the rest of patients. Conclusion Oral glutamine challenge identified patients at risk of HE and defined specific features of the episodes. This tool could be useful in the decision‐making process for the adequate management of HE.

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A Model for Predicting Development of Overt Hepatic Encephalopathy in Patients With Cirrhosis

Cited by 52 publications

References 36 publications

Screening for minimal hepatic encephalopathy in patients with cirrhosis by cirrhosis-related symptoms and a history of overt hepatic encephalopathy

Screening for minimal hepatic encephalopathy in patients with cirrhosis by cirrhosis-related symptoms and a history of overt hepatic encephalopathy

The modification of quantity and quality of muscle mass improves the cognitive impairment after TIPS

Oral glutamine challenge is a marker of altered ammonia metabolism and predicts the risk of hepatic encephalopathy

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