Clinical, neuropsychological and neurophysiological indices and predictors of hepatic encephalopathy (HE)

Abstract

Background and Aims: The occurrence of overt hepatic encephalopathy (HE) marks a significant progression in the natural history of liver disease. The aims of the present study were to: 1) describe a large cohort of patients with cirrhosis in terms of neuropsychological or neurophysiological HE indices, and 2) test if the severity of liver disease and/or any such indices [Psychometric Hepatic Encephalopathy Score (PHES), Scan test, electroencephalography (EEG)] predicted mortality/HE risk in a subgroup of such cohort. Method: Four hundred and sixty-one patients with cirrhosis (59 ± 10 years; 345 males) were included; information on previous overt HE episodes was available in 407. Follow-up information on mortality/HE-related hospitalization in 134/127 respectively. Information on previous overt HE episodes and both mortality and HErelated hospitalization over the follow-up in 124.Results: Patients with a history of overt HE (60%) had poorer liver function, worse neuropsychiatric indices, higher ammonia levels and higher prevalence of portal-systemic shunt. The risk of HE-related hospitalization over the follow-up was higher in patients with higher MELD score and worse Scan performance. Mortality was higher in those with higher MELD. Among patients without a history of overt HE, those with worse PHES had higher HE risk. Among patients with a history, those with higher MELD, better PHES and worse Scan performance had higher HE risk. Conclusions:In patients without previous overt HE episodes, neuropsychological and neurophysiological tests predict HE, while in those with previous overt HE episodes, HE development largely depends on the severity of liver dysfunction.

EASL Clinical Practice Guidelines on the management of hepatic encephalopathy

“…64 In patients without previous overt HE episodes, covert HE may predict overt HE, while in those with previous overt HE episodes, subsequent overt HE episodes depend more on the severity of liver dysfunction and/or portosystemic shunting. 65 A genetic risk score combining previous bouts of overt HE, genetic profile and liver dysfunction has been used to calculate the risk of HE during follow-up. 27 How to screen covert HE?…”

Prognosis and Survival Modelling in Cirrhosis Using Parenclitic Networks

“…The study population consists of 106 patients diagnosed with cirrhosis referred to the tertiary referral liver centre of the Clinica Medica V, Padova University Hospital, for formal hepatic encephalopathy assessment. Patients were enrolled between 2009 and 2018 according to the inclusion/exclusion criteria [for more information about patients' recruitment see Formentin et al (2021)].…”

Plasma ammonia levels predict hospitalisation with liver-related complications and mortality in clinically stable outpatients with cirrhosis

“…Endoscopic surveillance for varices is useful in determining the risk of variceal bleeding, neuropsychiatric tests provide insight into the risk of overt hepatic encephalopathy (HE) and detection of clinically significant portal hypertension using hepatic venous pressure gradient (HVPG) provides insights into the risk of development of liver-related complications. [3][4][5] However, measurement of HVPG is expensive, invasive, requires specialist equipment, and is not routinely available. A simple, cost-effective, and widely available tool to define the risk of future liver-related complications remains a key area of unmet need.…”