Impact of Hepatic Encephalopathy on Clinical Characteristics and Adverse Outcomes in Prospective and Multicenter Cohorts of Patients With Acute-on-Chronic Liver Diseases

Long, Liyuan; Li, Hai; Deng, Guohong; Wang, Xianbo; Lu, Sihong; Li, Beiling; Zhao, Meng; Gao, Yanhang; Qian, Zhiping; Liu, Feng; Lu, Xiaobo; Ren, Han; Shang, Jia; Wang, Shaoyang; Zheng, Yubao; Yan, Huadong; Yin, Shan; Tan, Wenting; Zhang, Qun; Zheng, Xin; Chen, Jinjun; Luo, Sen; Zhao, Jinming; Yuan, Wei; Li, Tao; Zheng, Rongjiong; Liu, Junping; Liu, Huan; Gu, Wenyi; Li, Sumeng; Xue, Mei; Chen, Ruochan; Huang, Yan

doi:10.3389/fmed.2021.709884

Cited by 10 publications

(8 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The incidence and prevalence of overt HE is higher in patients with alcohol-related cirrhosis than cirrhosis from other causes. 3,47 In a large study of Medicare patients, alcohol-related cirrhosis was most associated with incident HE. 3 The relationship between alcohol-related cirrhosis and CHE is less clear.…”

Section: Alcohol-related Liver Diseasementioning

confidence: 99%

Changing Epidemiology of Cirrhosis and Hepatic Encephalopathy

Louissaint

Deutsch‐Link

Tapper

2022

Clinical Gastroenterology and Hepatology

View full text Add to dashboard Cite

Section: Alcohol-related Liver Diseasementioning

confidence: 99%

Changing Epidemiology of Cirrhosis and Hepatic Encephalopathy

Louissaint

Deutsch‐Link

Tapper

2022

Clinical Gastroenterology and Hepatology

View full text Add to dashboard Cite

“…The North American Liver Failure Alliance (NACSELD) identified HE grades 3-4 as an independent predictor of 30-day mortality in hospitalized patients with cirrhosis, with 30-day mortality for HE grades 3-4 as high as 38% (32,33). Our previous study also demonstrated that the 28-day LT-free mortality rates were 34.5 and 55% for HE grades 3 and 4, respectively, among patients with cirrhosis and other chronic liver diseases (34). The results from the above studies and the results from our study demonstrated that grade 3-4 HE plays a more important role than the INR in the shortterm outcomes of patients with cirrhosis.…”

Section: Discussionmentioning

confidence: 80%

Increased INR Values Predict Accelerating Deterioration and High Short-Term Mortality Among Patients Hospitalized With Cirrhosis or Advanced Fibrosis

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background and Objective: An increase in the international normalized ratio (INR) is associated with increased mortality in patients with cirrhosis and other chronic liver diseases, while little is known about the quantitative relationship. This study aimed to investigate the quantitative relationship between the INR and short-term prognosis among patients hospitalized with cirrhosis or advanced fibrosis and to evaluate the role of the INR as a risk factor for short-term liver transplant (LT)-free mortality in these patients.Patients and Methods: This study prospectively analyzed multicenter cohorts established by the Chinese Acute-on-Chronic Liver Failure (CATCH-LIFE) study. Cox regression was used to describe the relationship between the INR and independent risk factors for short-term LT-free mortality. Forest plots were used in the subgroup analysis. Generalized additive models (GAMs) and splines were used to illustrate the quantitative curve relationship between the INR and the outcome and inflection point on the curve.Results: A total of 2,567 patients with cirrhosis and 924 patients with advanced fibrosis were included in the study. The 90-day LT-free mortality of patients with cirrhosis and advanced fibrosis was 16.7% (428/2,567) and 7.5% (69/924), respectively. In the multivariable Cox regression analysis, the increase in the INR was independently associated with the risk of 90-day LT-free mortality both in patients with cirrhosis (HR, 1.06; 95% CI, 1.04–1.07, p < 0.001) and in patients with advanced fibrosis (HR, 1.09; 95% CI, 1.06–1.12, p < 0.001). An INR of 1.6/1.7 was found to be the starting point of coagulation dysfunction with a rapid increase in mortality in patients with cirrhosis or in patients with advanced fibrosis, respectively. A 28-day LT-free mortality of 15% was associated with an INR value of 2.1 in both cirrhosis and advanced fibrosis patients.Conclusions: This study was the first to quantitatively describe the relationship between the INR and short-term LT-free mortality in patients with cirrhosis or advanced fibrosis. The starting points of INR indicating the rapid increase in mortality and the unified cutoff value of coagulation failure in cirrhosis and advanced fibrosis, will help clinicians accurately recognize early disease deterioration.

show abstract

“…The CLD, ALI, AD and AoCLD, as well as the exclusion criteria, have already been defined in published CATCH-LIFE manuscripts [ 3 , 13–15 ]. Acute-on-chronic liver failure (ACLF) [ 16 ] was defined according to the updated consensus recommendations of the European Association for the Study of Chronic Liver Failure consortium [ 17 ].…”

Section: Methodsmentioning

confidence: 99%

“…Chronic liver disease (CLD) is a growing cause of morbidity and mortality worldwide [ 1 ], particularly in low-to-middle income countries with a high economic burden and limited treatment availability [ 2 ]. Patients with CLD and acute events are considered to have acute-on-chronic liver disease (AoCLD) [ 3 ]. Acute events, including acute decompensation ( ad ) and acute liver injury (ALI), can aggravate liver dysfunction in patients with CLD and lead to liver failure if continued [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

A novel prognostic nomogram for older patients with acute-on-chronic liver diseases (AoCLD): a nationwide, multicentre, prospective cohort study

Zou

Deng

et al. 2023

Age and Ageing

Self Cite

View full text Add to dashboard Cite

Background the incidence of acute-on-chronic liver disease (AoCLD) is increasing. Objective to investigate the clinical features and risk factors of AoCLD and construct an effective prognostic nomogram model for older patients with AoCLD. Methods data from 3,970 patients included in the CATCH-LIFE study were used, including 2,600 and 1,370 patients in the training and validation sets, respectively. Multivariate Cox regression analyses were performed to identify predictive risk factors in older individuals, and an easy-to-use nomogram was established. Performance was assessed using area under the curve, calibration plots and decision curve analysis (DCA). Results of the 3,949 patients with AoCLD, 809 were older with a higher proportion of autoimmune-related abnormalities, hepatitis C viral infection and schistosomiasis. In the older patient group, the incidence of cirrhosis, hepatic encephalopathy (HE), infection, ascites and gastrointestinal bleeding; neutrophil-to-lymphocyte ratio (NLR), aspartate-to-alanine transaminase ratio (AST/ALT), creatinine and blood urea nitrogen levels were higher, whereas incidence of acute-on-chronic liver failure, white blood cell, platelet and haemoglobin levels; albumin, total bilirubin (TB), AST and ALT levels; international normalised ratio (INR), estimated glomerular filtration rate and blood potassium levels were lower than in the younger group. The final nomogram was developed based on the multivariate Cox analysis in training cohort using six risk factors: ascites, HE grades, NLR, TB, INR and AST/ALT. Liver transplantation-free mortality predictions were comparable between the training and validation sets. DCA showed higher net benefit for the nomograph than the treat-all or treat-none strategies, with wider threshold probabilities ranges. Conclusions our analysis will assist clinical predictions and prognoses in older patients with AoCLD.

show abstract

Impact of Hepatic Encephalopathy on Clinical Characteristics and Adverse Outcomes in Prospective and Multicenter Cohorts of Patients With Acute-on-Chronic Liver Diseases

Cited by 10 publications

References 31 publications

Changing Epidemiology of Cirrhosis and Hepatic Encephalopathy

Changing Epidemiology of Cirrhosis and Hepatic Encephalopathy

Increased INR Values Predict Accelerating Deterioration and High Short-Term Mortality Among Patients Hospitalized With Cirrhosis or Advanced Fibrosis

A novel prognostic nomogram for older patients with acute-on-chronic liver diseases (AoCLD): a nationwide, multicentre, prospective cohort study

Contact Info

Product

Resources

About