Minimal hepatic encephalopathy identifies patients at risk of faster cirrhosis progression

Ampuero, Javier; Montoliú, Carmina; Simón-Talero, Macarena; Aguilera, Virginia; Millán, Raquel; Marquez, C. Gutierrez; Jover, Rodrigo; Rico, María Carmen; Sendra, Carmen; Serra, Miguel; Romero‐Gómez, Manuel

doi:10.1111/jgh.13917

Cited by 41 publications

(34 citation statements)

References 24 publications

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“…MHE has also been shown to predict the development of overt HE (OHE) and is associated with poor survival . In addition, a long‐term prospective study revealed that MHE is significantly associated with the acceleration of cirrhosis progression and causes ascites, OHE, variceal bleeding, jaundice, sarcopenia, and mortality during the clinical course . These results indicate that the diagnosis of MHE is essential to predict the outcomes of patients with liver cirrhosis.…”

Section: Introductionmentioning

confidence: 97%

Prognostic significance of minimal hepatic encephalopathy in patients with liver cirrhosis in Japan: A propensity score‐matching analysis

Hanai

Shiraki

Watanabe

et al. 2019

J of Gastro and Hepatol

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Background and Aim Minimal hepatic encephalopathy (MHE) represents the mildest form of the hepatic encephalopathy spectrum. This study aimed to clarify the prognostic significance of MHE in cirrhotic patients. Methods This retrospective study evaluated 357 consecutive patients with liver cirrhosis. MHE was diagnosed using a neuropsychiatric test. A propensity score‐matching analysis was employed to adjust significant differences in the baseline characteristics between patients with and without MHE. Results Of 269 eligible patients, 56 patients (21%) were diagnosed as having MHE. The Child–Pugh score, model for end‐stage liver disease score, and serum ammonia levels were significantly increased, while serum albumin levels were reduced in patients with MHE. By contrast, no significant difference was found between the two groups in matched patients. During the median follow‐up period of 13.4 months, 67 patients (24.9%) died. Overall survival rates were significantly lower in patients with MHE (median, 25.4 vs 48.8 months; P < 0.001). Multivariate analysis revealed that male sex (hazard ratio [HR], 1.78; 95% confidence interval [CI], 1.03–3.18; P = 0.038), stage III/IV hepatocellular carcinoma (HR, 6.32; 95% CI, 3.30–12.79; P < 0.001), the Child–Pugh score (HR, 1.35; 95% CI, 1.12–1.62; P = 0.002), and MHE (HR, 1.92; 95% CI, 1.09–3.29; P = 0.024) were independently associated with mortality in all patients as well as in matched patients. Conclusion Minimal hepatic encephalopathy is associated with an increased risk of mortality in patients with liver cirrhosis, independent of hepatocellular carcinoma stage or Child–Pugh score.

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Section: Introductionmentioning

confidence: 97%

Prognostic significance of minimal hepatic encephalopathy in patients with liver cirrhosis in Japan: A propensity score‐matching analysis

Hanai

Shiraki

Watanabe

et al. 2019

J of Gastro and Hepatol

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“…However, even CHE leads to impaired quality of life, and each episode of OHE might lead to further cognitive impairment ( 4 , 5 ). Taken together, HE is a marker of poor prognosis, predicts progression of cirrhosis, and is associated with high mortality ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

Outcome Prediction of Covert Hepatic Encephalopathy in Liver Cirrhosis: Comparison of Four Testing Strategies

Labenz

Toenges

Schattenberg

et al. 2020

Clin Transl Gastroenterol

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INTRODUCTION: Despite the negative impact of covert hepatic encephalopathy on the outcome of patients with liver cirrhosis, data regarding the ability of different testing strategies to predict overt hepatic encephalopathy (OHE) development and mortality are limited. This study aimed to compare the ability of Psychometric Hepatic Encephalopathy Score (PHES), critical flicker frequency (CFF), simplified animal naming test (S-ANT1), and clinical covert hepatic encephalopathy (CCHE) score to predict OHE development and mortality. METHODS: A total of 224 patients with liver cirrhosis were tested with different testing strategies and prospectively followed up regarding clinically relevant outcomes (OHE or death/liver transplantation). RESULTS: Prevalence of pathological results varied among the testing strategies: PHES 33.9%, CFF 17.9%, S-ANT1 41.5%, and CCHE score 33.9%. All testing strategies were independent predictors of OHE development after adjusting for model of end-stage liver disease (MELD) score and history of OHE. The predictive performances of PHES (area under the receiver operating characteristic curve, 0.742) and CCHE (area under the receiver operating characteristic curve, 0.785) regarding OHE development during the next 180 days were significantly better than those of CFF and S-ANT1. In multivariable analysis, pathological results in PHES, S-ANT1, and CCHE score were independently associated with higher mortality. CFF did not correlate with mortality in the whole cohort. In the subgroup of patients with a MELD score <15, pathological results in PHES, CFF, or CCHE score were independent predictors of higher mortality. DISCUSSION: PHES and CCHE score predict OHE development and mortality in patients with liver cirrhosis. In particular, in patients with low MELD score, both testing strategies could help to identify patients who might benefit from liver transplantation.

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“…Cirrhosis is associated with multiple life-threatening complications such as intraabdominal infections, hepatic encephalopathy/coma (HC), portal hypertension, esophageal varices and hepatocellular carcinoma. These complications are suggestive of decompensated-cirrhosis and are indicative of worse prognosis among patients with cirrhosis[2,3]. In addition, patients with decompensated-cirrhosis, especially with HC, have a higher rate of early readmission and contribute to higher healthcare cost[4-6].…”

Section: Introductionmentioning

confidence: 99%

Temporal trends of cirrhosis associated conditions

Sempokuya

Zhang

Nakagawa

2019

WJH

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BACKGROUNDChronic liver disease and cirrhosis is the 12th leading cause of death in the United States. Patients with decompensated-cirrhosis, especially with hepatic encephalopathy/coma (HC), have a higher rate of early readmission and contribute to higher healthcare cost.AIMTo evaluate the national inpatient trends of discharges, mortalities and financial impacts associated with four common conditions of cirrhosis.METHODSThe publicly available Healthcare Cost and Utilization Project National Inpatient Sample database was utilized to examine the temporal trends of total number of discharges, mortalities and inpatient costs related to hospitalization with a primary diagnosis of HC, transjugular intrahepatic portosystemic shunt (TIPS), esophageal varices with bleeding (EV) and spontaneous bacterial peritonitis (SBP) from 2005 to 2014. The ten-year temporal trends were assessed using simple linear regressions and multiple regression analysis. Two-sided P < 0.05 was considered statistically significant.RESULTSFrom 2005 to 2014, the total number of discharges with cirrhosis-associated complications trended up for HC, SBP and EV (HC by 70% increase, P < 0.0001; SBP by 819% increase, P = 0.0002; EV by 9% increase, P = 0.016), but not for TIPS (P = 0.90). HC related to viral hepatitis showed faster increase by 357% (P < 0.0001) in comparison to HC not related to viral hepatitis by 33 % (P = 0.0006). Overall, in-hospital mortality rates for each condition decreased from 2005 to 2014 (HC by 29% reduction, P = 0.0024; SBP by 26% reduction, P = 0.0038; TIPS by 32% reduction, P = 0.021) except for EV (P = 0.34). After adjustment for inflation, aggregate cost of hospitalization for EV, HC, and SBP significantly increased by 20%, 86%, and 980%, respectively, from 2005 to 2014 (all P < 0.02), while TIPS had trend toward decreasing cost by 3% (P = 0.95).CONCLUSIONThe number of hospitalizations and costs for some of the cirrhosis-associated conditions increased. However, the inpatient mortality rates for most of these conditions decreased.

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Minimal hepatic encephalopathy identifies patients at risk of faster cirrhosis progression

Cited by 41 publications

References 24 publications

Prognostic significance of minimal hepatic encephalopathy in patients with liver cirrhosis in Japan: A propensity score‐matching analysis

Prognostic significance of minimal hepatic encephalopathy in patients with liver cirrhosis in Japan: A propensity score‐matching analysis

Outcome Prediction of Covert Hepatic Encephalopathy in Liver Cirrhosis: Comparison of Four Testing Strategies

Temporal trends of cirrhosis associated conditions

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