Incidence and Bedside Predictors of the First Episode of Overt Hepatic Encephalopathy in Patients With Cirrhosis

Tapper, Elliot B.; Zhao, Lilli; Nikirk, Samantha; Baki, Jad; Parikh, Neehar D.; Lok, Anna S.; Waljee, Akbar K.

doi:10.14309/ajg.0000000000000762

Cited by 45 publications

(43 citation statements)

References 49 publications

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“…Risk factors for MHE in our study were use of diuretics and decompensated cirrhosis, as previously described 21 , 22 , suggesting that our population was appropriate to evaluate response to rifaximin.…”

Section: Discussionsupporting

confidence: 65%

Metabolic syndrome is associated with poor response to rifaximin in minimal hepatic encephalopathy

Ballester

Gallego

Fiorillo

et al. 2022

Sci Rep

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Patients with cirrhosis may show minimal hepatic encephalopathy (MHE), for which rifaximin is effective. Metabolic syndrome may be associated with cognitive impairment. Our aims were to evaluate the influence of metabolic syndrome features on response to rifaximin for neurological and inflammatory alterations in MHE. A prospective cohort study was conducted in 63 cirrhotic patients and 30 controls from two tertiary centres recruited between 2015 and 2019. Metabolic syndrome was defined according to the Adult Treatment Panel-III. Patients were classified into 31 without and 32 with MHE according to the Psychometric Hepatic Encephalopathy Score (PHES). All participants performed specific psychometric tests, and inflammatory parameters were studied. Patients with MHE received rifaximin (400 mg/8 h). Response was evaluated by PHES at 3 and 6 months. Response according to metabolic syndrome manifestations was compared. The response rate was 66%. Older age (p = 0.012) and all metabolic syndrome diseases (p < 0.05) were associated with non-response, plus an increase in risk as the number of manifestations rose (p < 0.001). Patients with metabolic manifestations exhibited worse processing speed (p = 0.011), working memory (p = 0.005), visual coordination (p = 0.013) and lower proportion of activated CD4+ lymphocytes (p = 0.039) at baseline, as well as worse concentration (p = 0.030), bimanual coordination (p = 0.004) and higher levels of intermediate monocytes (p = 0.026), CX3CL1 (p < 0.05), IL-17 (p = 0.022), AHR (p = 0.010) and IgG (p < 0.05) at 3 and/or 6 months of rifaximin. Patients with clinical signs of metabolic syndrome have poor response to rifaximin for MHE, with a higher proportion of neurological alterations associated with a pro-inflammatory environment.

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Section: Discussionsupporting

confidence: 65%

Metabolic syndrome is associated with poor response to rifaximin in minimal hepatic encephalopathy

Ballester

Gallego

Fiorillo

et al. 2022

Sci Rep

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“…Hepatic encephalopathy is a neurological disorder related to the severe decline of liver function. Tapper et al (5) found that 21% of cirrhotic patients with Child-Pugh grade A and B liver function developed hepatic encephalopathy within 1 year. The research of Cordoba et al (6) showed that the mortality of patients with chronic and acute liver failure complicated with hepatic encephalopathy was significantly higher than that of patients without hepatic encephalopathy, which is consistent with the results of this study.…”

Section: Discussionmentioning

confidence: 99%

Risk factors and prognostic model for HBV-related subacute liver failure

Yang

et al. 2022

Ann Transl Med

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Background:The prognosis for patients with chronic hepatitis B virus (HBV)-related subacute liver failure is poor. Thus, accurate prognostication would facilitate management and optimize liver allocation. This study aimed to explore the risk factors for HBV-related subacute liver failure and establish a risk model. Methods: A total of 192 patients with HBV-related subacute liver failure treated at the First Affiliated Hospital of Xi'an Jiaotong University during January 2018 to January 2019 were selected and divided into the survival group (n=113) and the death group (n=79) based on their status within 6 months. Patient information were collected, including age, sex, body mass index, complications, hepatitis B e antigen (HBeAg), hepatic encephalopathy, hepatorenal syndrome, infections, ascites, HBV-DNA, Model for End-Stage Liver Disease (MELD), liver function tests, international normalized ratio (INR), serum creatinine and total cholesterol. Binary logistic regression was employed to identify risk factors for risk model establishment. The predictive value of the risk model was assessed with a receiver operating characteristic (ROC) curve. Results: Compared with the survival group, the patient age, incidence of hepatic encephalopathy and hepatorenal syndrome, infection and ascites rate, MELD score, and alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), INR, and serum creatinine levels were significantly elevated, whereas the total cholesterol level was significantly decreased in the death group (all P<0.05). Patient age [odds ratio (OR) =1.11, P=0.03], hepatic encephalopathy (OR =8.31, P=0.02), infection (OR =4.27, P=0.005), ascites (OR =4.54, P=0.006), MELD score (OR =1.39, P<0.001), INR (OR =5.89, P=0.001), and total cholesterol (OR =0.31, P=0.002) were identified as prognostic factors affecting patient mortality. Although both the MELD score and the risk model established in the present study could differentiate patient outcomes, the area under the curve (AUC) (0.94 vs. 0.82, P<0.001) and sensitivity (91.1% vs. 58.2%, P<0.001) of the established risk model were significantly higher than those of the MELD score. Conclusions: Patient age, hepatic encephalopathy, infection, ascites, MELD score, INR, and total cholesterol level were independent prognostic factors. The prognostic model established based on these risk factors may have favorable predictive value.

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“…Our study proposes a new neuroimaging biomarker for the detection of MHE. As we know, MHE has the potential to progress into OHE, which can cause irreversible brain damage (Tapper et al, 2020). Studies have shown that MHE can be reversed by prompt treatment (Abid et al, 2020;Butterworth & McPhail, 2019;Nardone et al, 2016); therefore, it is important to diagnose and treat MHE before major neurological damage occurs.…”

Section: Discussionmentioning

confidence: 99%

Identification of minimal hepatic encephalopathy based on dynamic functional connectivity

Cheng

Zhang

et al. 2021

Brain Imaging and Behavior

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To investigate whether dynamic functional connectivity (DFC) metrics can better identify minimal hepatic encephalopathy (MHE) patients from cirrhotic patients without any hepatic encephalopathy (noHE) and healthy controls (HCs). Resting-state functional MRI data were acquired from 62 patients with cirrhosis (MHE, n=30; noHE, n=32) and 41 HCs. We used the sliding time window approach and functional connectivity analysis to extract the time-varying properties of brain connectivity. Three DFC characteristics (i.e., strength, stability, and variability) were calculated. For comparison, we also calculated the static functional connectivity (SFC). A linear support vector machine was used to differentiate MHE patients from noHE and HCs using DFC and SFC metrics as classi cation features. The leave-one-out cross-validation method was used to estimate the classi cation performance. The strength of DFC (DFC-Dstrength) achieved the best accuracy (MHE vs. noHE, 72.5%; MHE vs. HCs, 84%; and noHE vs. HCs, 88%) compared to the other dynamic features. Compared to static features, the classi cation accuracies of the DFC-Dstrength feature were improved by 10.5%, 8%, and 14% for MHE vs. noHE, MHE vs. HC, and noHE vs. HCs, respectively. Based on the DFC-Dstrength, seven nodes were identi ed as the most discriminant features to classify MHE from noHE, including left inferior parietal lobule, left supramarginal gyrus, left calcarine, left superior frontal gyrus, left cerebellum, right postcentral gyrus, and right insula. In summary , DFC characteristics have a higher classi cation accuracy in identifying MHE from cirrhosis patients. Our ndings suggest the usefulness of DFC in capturing neural processes and identifying disease-related biomarkers important for MHE identi cation.

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Incidence and Bedside Predictors of the First Episode of Overt Hepatic Encephalopathy in Patients With Cirrhosis

Cited by 45 publications

References 49 publications

Metabolic syndrome is associated with poor response to rifaximin in minimal hepatic encephalopathy

Metabolic syndrome is associated with poor response to rifaximin in minimal hepatic encephalopathy

Risk factors and prognostic model for HBV-related subacute liver failure

Identification of minimal hepatic encephalopathy based on dynamic functional connectivity

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