Increasing Burden of Hepatic Encephalopathy Among Hospitalized Adults: An Analysis of the 2010–2014 National Inpatient Sample

Hirode, Grishma; Vittinghoff, Eric; Wong, Robert J.

doi:10.1007/s10620-019-05576-9

Cited by 52 publications

(42 citation statements)

References 31 publications

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“…1,2 Hospitalizations due to HE in the USA increased over the period of 2010 to 2014, from 25,039 to 31,182, though in-hospital mortality decreased from 13.4% to 12.3%. 3 In addition to this, HE in-patient charges increased from 8.15 billion USD to 11.9 billion USD over the same time period. 3 Therefore, it is evident that HE is a significant financial burden on health care systems and the development of this syndrome is associated with poor patient prognosis and mortality.…”

Section: Introductionmentioning

confidence: 93%

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The Direct Contribution of Astrocytes and Microglia to the Pathogenesis of Hepatic Encephalopathy

Jaeger

DeMorrow

McMillin

2019

Journal of Clinical and Translational Hepatology

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Hepatic encephalopathy is a neurological complication resulting from loss of hepatic function and is associated with poor clinical outcomes. During acute liver failure over 20% of mortality can be associated with the development of hepatic encephalopathy. In patients with liver cirrhosis, 1-year survival for those that develop overt hepatic encephalopathy is under 50%. The pathogenesis of hepatic encephalopathy is complicated due to the multiple disruptions in homeostasis that occur following a reduction in liver function. Of these, elevations of ammonia and neuroinflammation have been shown to play a significant contributing role to the development of hepatic encephalopathy. Disruption of the urea cycle following liver dysfunction leads to elevations of circulating ammonia, which enter the brain and disrupt the functioning of astrocytes. This results in dysregulation of metabolic pathways in astrocytes, oxidative stress and cerebral edema. Besides ammonia, circulating chemokines and cytokines are increased following liver injury, leading to activation of microglia and a subsequent neuroinflammatory response. The combination of astrocyte dysfunction and microglia activation are significant contributing factors to the pathogenesis of hepatic encephalopathy.

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Section: Introductionmentioning

confidence: 93%

“…3 In addition to this, HE in-patient charges increased from 8.15 billion USD to 11.9 billion USD over the same time period. 3 Therefore, it is evident that HE is a significant financial burden on health care systems and the development of this syndrome is associated with poor patient prognosis and mortality.…”

Section: Introductionmentioning

confidence: 93%

The Direct Contribution of Astrocytes and Microglia to the Pathogenesis of Hepatic Encephalopathy

Jaeger

DeMorrow

McMillin

2019

Journal of Clinical and Translational Hepatology

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“…In a claims database of privately insured persons, we found that the overall cumulative incidence of death at 1 year was 19% [25]. Stepanova and Hirode both examined the NIS and found that the in-hospital mortality and costs associated with hospitalizations for HE from 2005 to 2014 were approximately 17% and $17,000 [43,44]. Roggeri examined the global annual health care costs for Italian patients with HE and estimated approximately $15,000 USD [45].…”

Section: Outcomes Of Hementioning

confidence: 99%

The Use of Administrative Data to Investigate the Population Burden of Hepatic Encephalopathy

Bloom

Tapper

2020

JCM

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Hepatic encephalopathy (HE) is a devastating complication of cirrhosis with an increasing footprint in global public health. Although the condition is defined using a careful history and examination, we cannot accurately measure the true impact of HE relying on data collected exclusively from clinical studies. For this reason, administrative data sources are necessary to study the population burden of HE. Administrative data is generated with each health care encounter to account for health care resource utilization and is extracted into a dataset for the secondary purpose of research. In order to utilize such data for valid analysis, several pitfalls must be avoided—specifically, selecting the particular database capable of meeting the needs of the study’s aims, paying careful attention to the limits of each given database, and ensuring validity of case definition for HE specific to the dataset. In this review, we summarize the types of data available for and the results of administrative data studies of HE.

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“…The development of hepatic encephalopathy (HE) remains a poor prognostic sign for patients with cirrhosis. Hepatic encephalopathy is responsible for rising hospital readmission rates, high health care costs, transplant list mortality, inpatient and outpatient mortality, and poor quality of life . Meanwhile, therapeutic options for HE remain stagnant—with the most recent FDA drug approval in 2010.…”

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confidence: 99%

Editorial: mind the gaps ‐ an important first step towards improving hepatic encephalopathy care

Bloom

Chung

2019

Aliment Pharmacol Ther

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22% of patients admitted with HE underwent a complete infectious evaluation on admission; thus, future research should specifically explore quality gaps in infection-precipitated HE. 8The work of Bajaj et al should help direct future HE interventions towards medication-related precipitating factors, especially lactulose nonadherence, aspiration pneumonia prevention and more assiduous monitoring of HE treatments at and after discharge.

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Increasing Burden of Hepatic Encephalopathy Among Hospitalized Adults: An Analysis of the 2010–2014 National Inpatient Sample

Cited by 52 publications

References 31 publications

The Direct Contribution of Astrocytes and Microglia to the Pathogenesis of Hepatic Encephalopathy

The Direct Contribution of Astrocytes and Microglia to the Pathogenesis of Hepatic Encephalopathy

The Use of Administrative Data to Investigate the Population Burden of Hepatic Encephalopathy

Editorial: mind the gaps ‐ an important first step towards improving hepatic encephalopathy care

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