Changing Epidemiology of Cirrhosis and Hepatic Encephalopathy

Louissaint, Jeremy; Deutsch‐Link, Sasha; Tapper, Elliot B.

doi:10.1016/j.cgh.2022.04.036

Cited by 24 publications

(15 citation statements)

References 97 publications

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“…We also found that older age was an independent risk factor for post-TIPS OHE (OR: 1.041, 95% CI: 1.004-1.080; p = 0.030), which was consistent with the results reported by previous studies [20]. Age-related neurocognitive changes and body compositional changes such as myosteatosis and sarcopenia can both contribute to a high risk for the development of OHE in older age [47]. Age and BMI may interact together for the prevalence of OHE.…”

Section: Discussionsupporting

confidence: 91%

Overweight/Obesity Increases the Risk of Overt Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt in Cirrhotic Patients

Yin

Cheng

et al. 2023

JPM

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The purpose of this study was to investigate the effect of body mass index (BMI) on the prevalence of overt hepatic encephalopathy (OHE) after the transjugular intrahepatic portosystemic shunt (TIPS) procedure in decompensated cirrhotic patients. A retrospective observational cohort study of 145 cirrhotic patients receiving TIPS was carried out in our department from 2017 to 2020. The relationships between BMI and clinical outcomes including OHE, as well as risk factors of developing post-TIPS OHE, were analyzed. BMI was categorized as normal weight (18.5 ≤ BMI < 23.0 kg/m2), underweight (BMI < 18.5 kg/m2), and overweight/obese (BMI ≥ 23.0 kg/m2). Among the 145 patients, 52 (35.9%) were overweight/obese and 50 (34%) had post-TIPS OHE. Overweight/obese patients more frequently had OHE compared with normal weight patients (OR: 2.754, 95% CI: 1.236–6.140; p = 0.013). Overweight/obesity (p = 0.013) and older age (p = 0.030) were independent risk factors for post-TIPS OHE according to the logistic regression analysis. Kaplan–Meier curve analysis suggested that overweight/obese patients had the highest cumulative incidence of OHE (log-rank p = 0.0118). In conclusion, overweight/obesity and older age may raise the risk of post-TIPS OHE in cirrhotic patients.

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Section: Discussionsupporting

confidence: 91%

Overweight/Obesity Increases the Risk of Overt Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt in Cirrhotic Patients

Yin

Cheng

et al. 2023

JPM

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“…The prevalence of CHE has been reported to be very high in patients with cirrhosis, but estimates vary considerably among studies depending on, for example, the diagnostic method and the severity of cirrhosis[ 79 ]. In a prospective multicenter study, the prevalence of MHE under the combined diagnostic criteria based on the critical flicker frequency (CFF) and Psychometric Hepatic Encephalopathy Score (PHES) was 18.2%, with 12.1% of patients having compensated cirrhosis and 22.5% of patients showing decompensated cirrhosis[ 80 ].…”

Section: Epidemiology Of Major Complicationsmentioning

confidence: 99%

“…The prevalence of CHE varied among the different diagnostic sets, with rates of 18%, 25%, 29%, 35%, 37% and 54% for the PHES + ICT, ICT + Stroop EncephAlapp (StE), PHES + StE, ICT, PHES, and StE, respectively[ 83 ]. In addition, the underestimation of the burden of HE and other factors that may be regionally variable, such as smoking, diabetes, and alcohol intake, can impact the diagnosis of CHE[ 79 ], all contributing to the significant variability in the prevalence of CHE.…”

Section: Epidemiology Of Major Complicationsmentioning

confidence: 99%

“…Moreover, HE is associated with an increased risk of falls and can cause serious outcomes leading to high comorbidity and mortality[ 95 ]. In socioeconomic terms, cognitive impairment due to HE has been shown to have a multilevel association with adverse outcomes of employment/income, driving ability, and HRQOL[ 79 ].…”

Section: Epidemiology Of Major Complicationsmentioning

confidence: 99%

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Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions

Liu¹,

Chen²

2022

World J Gastroenterol

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Cirrhosis causes a heavy global burden. In this review, we summarized up-to-date epidemiological features of cirrhosis and its complications. Recent epidemiological studies reported an increase in the prevalence of cirrhosis in 2017 compared to in 1990 in both men and women, with 5.2 million cases of cirrhosis and chronic liver disease occurring in 2017. Cirrhosis caused 1.48 million deaths in 2019, an increase of 8.1% compared to 2017. Disability-adjusted life-years due to cirrhosis ranked 16th among all diseases and 7th in people aged 50-74 years in 2019. The global burden of hepatitis B virus and hepatitis C virus-associated cirrhosis is decreasing, while the burden of cirrhosis due to alcohol and nonalcoholic fatty liver disease (NAFLD) is increasing rapidly. We described the current epidemiology of the major complications of cirrhosis, including ascites, variceal bleeding, hepatic encephalopathy, renal disorders, and infections. We also summarized the epidemiology of hepatocellular carcinoma in patients with cirrhosis. In the future, NAFLD-related cirrhosis will likely become more common due to the prevalence of metabolic diseases such as obesity and diabetes, and the prevalence of alcohol-induced cirrhosis is increasing. This altered epidemiology should be clinically noted, and relevant interventions should be undertaken.

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“…Due to the potential impact of the liver filtrates and products on multiple organ systems ( Hadjihambi et al, 2018 ; Herrero et al, 2020 ), conditions leading to hepatic failure can be debilitating and life-threatening and require early diagnosis and careful management ( Squires et al, 2018 ; Ginès et al, 2021 ; Søreide and Deshpande, 2021 ). Interestingly, patients with chronic liver disease or liver failure often develop neurological complications ( Louissaint et al, 2022 ), suggesting the breach of non-effectively removed toxins or normal peripheral-restricted liver metabolic byproducts with direct effects in the nervous system ( McMillin et al, 2016 ) or the liver-dependent dysregulation of the immune system affecting the neurological outcome ( Sureka et al, 2015 ). Specifically, dysregulated bile acid (BA) metabolism and levels are associated with the rapid deterioration of neurological function in various neurological diseases ( Crick et al, 2017 ; Chen et al, 2019 ), as opposed to observed neuroprotective functions of the BAs ( Moreira et al, 2017 ; Graham et al, 2018 ; Thams et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Liver’s influence on the brain through the action of bile acids

et al. 2023

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The liver partakes as a sensor and effector of peripheral metabolic changes and a regulator of systemic blood and nutrient circulation. As such, abnormalities arising from liver dysfunction can influence the brain in multiple ways, owing to direct and indirect bilateral communication between the liver and the brain. Interestingly, altered bile acid composition resulting from perturbed liver cholesterol metabolism influences systemic inflammatory responses, blood-brain barrier permeability, and neuron synaptic functions. Furthermore, bile acids produced by specific bacterial species may provide a causal link between dysregulated gut flora and neurodegenerative disease pathology through the gut-brain axis. This review will cover the role of bile acids—an often-overlooked category of active metabolites—in the development of neurological disorders associated with neurodegeneration. Further studies into bile acid signaling in the brain may provide insights into novel treatments against neurological disorders.

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Changing Epidemiology of Cirrhosis and Hepatic Encephalopathy

Cited by 24 publications

References 97 publications

Overweight/Obesity Increases the Risk of Overt Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt in Cirrhotic Patients

Overweight/Obesity Increases the Risk of Overt Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt in Cirrhotic Patients

Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions

Liver’s influence on the brain through the action of bile acids

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