Inadequate practices for hepatic encephalopathy management in the inpatient setting

Shaw, Jawaid; Beyers, Lisa; Bajaj, Jasmohan S.

doi:10.1002/jhm.12897

Cited by 3 publications

(2 citation statements)

References 73 publications

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“…( 8 ) In addition, in the absence of timely outpatient cirrhosis management, it can result in increased rates of emergency department (ED) presentation for preventable hepatic encephalopathy, emergency paracentesis, and variceal bleeding, all of which are associated with significant economic costs and mortality. ( 7 – 9 )…”

Section: Introductionmentioning

confidence: 99%

A Pilot Study to Evaluate a New Hep-GRP Care Pathway to Improve Outcomes Among Canadian Older Adults with Liver Cirrhosis

Zhu,

Carr,

Sun

et al. 2024

Can Geriatr J

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Background Older adults with cirrhosis have complex medical needs that are not satisfied by organ specific management. Interdisciplinary approach may mitigate comorbidity and improve patient satisfaction. Methods A pilot study consisted of dual specialist interdisciplinary referral pathway and mixed virtual care delivery model are prospectively evaluated in older adults (65 years and older) with cirrhosis during the COVID-19 pandemic between September and December 2022. Participant attitudes towards telemedicine were surveyed. Results 68 participants with cirrhosis were consecutively assessed by hepatology. The mean age was 73 years. 39 (57%) screened positive for one or more geriatric syndrome(s). Comprehensive geriatric assessments were conducted via telemedicine in 18 participants, with additional referrals to physiotherapy and nutritional education. Compared to a historic cohort matched for age, sex, and Child-Pugh class, acute health service utilization measured by ER visits among those received dual specialist interdisciplinary consultation were lowered by 1.11 per patient at three-month follow up period (p = .0006, 95% CI 0.47–1.74). Majority participants (87.6%) preferred telemedicine or mixed method visits. Conclusion An interdisciplinary approach to older adults with cirrhosis will likely be beneficial, and routine screening for geriatric syndrome may lead to reduced acute health-care utilization in the short term. Telemedicine and virtual screening tools in seniors should be fully explored to improve access to care.

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Section: Introductionmentioning

confidence: 99%

A Pilot Study to Evaluate a New Hep-GRP Care Pathway to Improve Outcomes Among Canadian Older Adults with Liver Cirrhosis

Zhu,

Carr,

Sun

et al. 2024

Can Geriatr J

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“…Decompensated cirrhosis is marked by entirely symptomatic overt HE (OHE), occurring in 30-40% of cases, while minimal HE (MHE) affects 20-80% of cirrhosis patients [14]. The US has seen a rise in HE cases, with related hospitalizations increasing by 33% in 2018 and the cost for each patient per week averaging USD 20,000 [16][17][18]. HE is also a major health concern all over the world.…”

Section: Introductionmentioning

confidence: 99%

Age and Sex in the Development of Hepatic Encephalopathy: Role of Alcohol

Tong,

Hussain,

Shamaladevi

et al. 2024

Biology

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Hepatic encephalopathy (HE) is a neurological condition linked to liver failure. Acute HE (Type A) occurs with acute liver failure, while chronic HE (Type C) is tied to cirrhosis and portal hypertension. HE treatments lag due to gaps in understanding its development by gender and age. We studied how sex and age impact HE and its severity with combined liver toxins. Our findings indicate that drug-induced (thioacetamide, TAA) brain edema was more severe in aged males than in young males or young/aged female rats. However, adding alcohol (ethanol, EtOH) worsens TAA’s brain edema in both young and aged females, with females experiencing a more severe effect than males. These patterns also apply to Type A HE induced by azoxymethane (AZO) in mice. Similarly, TAA-induced behavioral deficits in Type C HE were milder in young and aged females than in males. Conversely, EtOH and TAA in young/aged males led to severe brain edema and fatality without noticeable behavioral changes. TAA metabolism was slower in aged males than in young or middle-aged rats. When TAA-treated aged male rats received EtOH, there was a slow and sustained plasma level of thioacetamide sulfoxide (TASO). This suggests that with EtOH, TAA-induced HE is more severe in aged males. TAA metabolism was similar in young, middle-aged, and aged female rats. However, with EtOH, young and aged females experience more severe drug-induced HE as compared to middle-aged adult rats. These findings strongly suggest that gender and age play a role in the severity of HE development and that the presence of one or more liver toxins may aggravate the severity of the disease progression.

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Inadequate practices for hepatic encephalopathy management in the inpatient setting

Shaw

Beyers

Bajaj

2022

Journal of Hospital Medicine

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Hepatic encephalopathy (HE) is an important complication of decompensated liver disease. Hospital admission for episodes of HE are very common, with these patients being managed by the hospitalists. These admissions are costly and burdensome to the health‐care system. Diagnosis of HE at times is not straightforward, particularly in patients who are altered and unable to provide any history. Precipitants leading to episodes of HE, should be actively sought and effectively tackled along with the overall management. This mandates timely diagnostics, appropriate initiation of pharmacological treatment, and supportive care. Infections are the most important precipitants leading to HE and should be aggressively managed. Lactulose is the front‐line medication for primary treatment of HE episodes and for prevention of subsequent recurrence. However, careful titration in the hospital setting along with the appropriate route of administration should be established and supervised by the hospitalist. Rifaximin has established its role as an add‐on medication, in those cases where lactulose alone is not working. Overall effective management of HE calls for attention to guideline‐directed nutritional requirements, functional assessment, medication reconciliation, patient education/counseling, and proper discharge planning. This will potentially help to reduce readmissions, which are all too common for HE patients. Early specialty consultation may be warranted in certain conditions. Numerous challenges exist to optimal care of hospitalized OHE patients. However, hospitalists if equipped with knowledge about a systematic approach to taking care of these frail patients are in an ideal position to ensure good inpatient and transition of care outcomes.

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Inadequate practices for hepatic encephalopathy management in the inpatient setting

Cited by 3 publications

References 73 publications

A Pilot Study to Evaluate a New Hep-GRP Care Pathway to Improve Outcomes Among Canadian Older Adults with Liver Cirrhosis

A Pilot Study to Evaluate a New Hep-GRP Care Pathway to Improve Outcomes Among Canadian Older Adults with Liver Cirrhosis

Age and Sex in the Development of Hepatic Encephalopathy: Role of Alcohol

Inadequate practices for hepatic encephalopathy management in the inpatient setting

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