Prediction and Risk Factors for Prognosis of Cirrhotic Patients with Hepatic Encephalopathy

Peng, Ying; Wei, Qinglin; Liu, Yun; Wu, Zhenyu; Zhang, Hongjia; Wu, Hongbo; Chai, Jin

doi:10.1155/2021/5623601

Cited by 11 publications

(16 citation statements)

References 29 publications

(25 reference statements)

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“…Although its p value was not small enough to allow us to claim statistical significance (p value = 0.055), the degree of association with an OR of 2.24 made it worth commenting on. In addition, its clinical importance was supported by findings from various studies [ 36 – 38 ]. Further study with a larger sample size may be needed.…”

Section: Discussionmentioning

confidence: 79%

Validation of prognostic scores predicting mortality in acute liver decompensation or acute-on-chronic liver failure: A Thailand multicenter study

et al. 2022

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Background & objectives Cirrhosis patients with worsening of the liver function are defined as acute decompensation (AD) and those who develop extrahepatic organ failure are defined as acute-on-chronic liver failure (ACLF). Both AD and ACLF have an extremely poor prognosis. However, information regarding prognostic predictors is still lacking in Asian populations. We aimed to identify prognostic factors for 30-day and 90-day mortality in cirrhosis patients who develop AD with or without ACLF. Methods We included 9 tertiary hospitals from Thailand in a retrospective observational study enrolling hospitalized cirrhosis patients with AD. ACLF was diagnosed according to the EASL-CLIF criteria, which defined as AD patients who have kidney failure or a combination of at least two non-kidney organ failure. Outcomes were clinical parameters and prognostic scores associated with mortality evaluated at 30 days and 90 days. Results Between 2015 and 2020, 602 patients (301 for each group) were included. The 30-day and 90-day mortality rates of ACLF vs. AD were 57.48% vs. 25.50% (p<0.001) and 67.44% vs. 32.78% (p<0.001), respectively. For ACLF patients, logistic regression analysis adjusted for demographic data, and clinical information showed that increasing creatinine was a predictor for 30-day mortality (p = 0.038), while the CLIF-C OF score predicted both 30-day (p = 0.018) and 90-day (p = 0.037) mortalities, achieving the best discriminatory power with AUROCs of 0.705 and 0.709, respectively. For AD patients, none of the parameters was found to be significantly associated with 30-day mortality, while bacterial infection, CLIF-AD score and Child-Turcotte-Pugh score were independent parameters associated with 90-day mortality, with p values of 0.041, 0.024 and 0.024. However, their predictive performance became nonsignificant after adjustment by multivariate regression analysis. Conclusions Regarding Thai patients, the CLIF-C OF score was the best predictor for 30-day and 90-day mortalities in ACLF patients, while appropriate prognostic factors for AD patients remained inconclusive.

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Section: Discussionmentioning

confidence: 79%

Validation of prognostic scores predicting mortality in acute liver decompensation or acute-on-chronic liver failure: A Thailand multicenter study

et al. 2022

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“…Endoscopic therapy is effective in controlling AVB especially in Child-Pugh class C cirrhotic patients while early TIPS has not been con rmed the effect on survival of these patients [21,22]. Child-Pugh was superior to the other factors in HE patients for prediction of in-hospital mortality [23,24], and also an important risk factors for predicting postoperative mortality in cirrhotic patients [25]. Five death cases in present study were all Child-Pugh class C, which is consistent with previous research.…”

Section: Discussionmentioning

confidence: 93%

General Anesthesia in Patients with Hepatic Encephalopathy and Acute Variceal Bleeding Undergoing Endoscopic Treatment: A Retrospective Study

Chen

Wen

Zhong

et al. 2022

Preprint

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Background: The management of cirrhotic patient with encephalopathy and acute variceal bleeding（AVB） remains a clinical challenge with a high mortality. Early endoscopic therapies are frequently applied in patients with AVB. However, the application of general anesthesia in endoscopic surgery for patients with hepatic encephalopathy (HE) is pretty challenging. The present study aimed to evaluate the possible effect of general anesthesia with tracheal intubation on patient complicated with encephalopathy and AVB during endoscopic procedure. Methods: Thirty-six cirrhotic patients with encephalopathy and AVB were retrospectively studied, 14 patients underwent endoscopic treatment under general anesthesia with tracheal intubation, and 22 patients received pharmacological treatment, or and endoscopic therapy without general anesthesia served as control group. Routine clinical and laboratory data were collected. Results: The total mortality rate was 13.9% (5/36), 2(14.3%) in anesthesia group, 3 (13.6%) in control group. The child-Pugh class of death cases were all grade C，3 (60%) of them were in the stage IV of HE. The stage of HE was all improved in the two groups, 12 (85.8 %) patients were totally recovered from consciousness disturbance in anesthesia group and 16 (72.7 %) in control group respectively, the difference between the two groups was not significant (P＞0.05). Except the death cases, there were still 3 patients in control group had impaired consciousness at discharge. Child-Pugh score, Child-Pugh class and the stage of HE in anesthesia group were significantly improved at discharge compared with those before operation. Conclusions: General anesthesia does not aggravate the severity of encephalopathy, and endoscopic treatment under general anesthesia with tracheal intubation is effective for HE patients complicated with AVB.

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“…Second, high serum levels of INR and TBIL generally indicate coagulation failure and liver failure, respectively. Many prognostic studies have reported that the abovementioned parameters are indicators of survival in patients with liver diseases [ 22 , 23 ]. Furthermore, the parameters are widely used in prognostic scores for patients with ACLF [ 14 , 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

A novel nomogram to predict 90-day mortality in patients with hepatitis B virus-related acute-on-chronic liver failure: a single-center retrospective study

et al. 2023

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Background Acute-on-chronic liver failure (ACLF) is a critical illness with high mortality. Herein, we developed and validated a new and simple prognostic nomogram to predict 90-day mortality in hepatitis B virus-related ACLF (HBV-ACLF) patients. Methods This single-center retrospective study collected data from 181 HBV-ACLF patients treated between June 2018 and March 2020. The correlation between clinical data and 90-day mortality in patients with HBV-ACLF was assessed using univariate and multivariate logistic regression analyses. Results Multivariate logistic regression analysis showed that age (p = 0.011), hepatic encephalopathy (p = 0.001), total bilirubin (p = 0.007), international normalized ratio (p = 0.006), and high-density lipoprotein cholesterol (p = 0.011) were independent predictors of 90-day mortality in HBV-ACLF patients. A nomogram was created to predict 90-day mortality using these risk factors. The C-index for the prognostic nomogram was calculated as 0.866, and confirmed to be 0.854 via bootstrapping verification. The area under the curve was 0.870 in the external validation cohort. The predictive value of the nomogram was similar to that of the Chinese Group on the Study of Severe Hepatitis B score, and exceeded the performance of other prognostic scores. Conclusion The prognostic nomogram constructed using the factors identified in multivariate regression analysis might serve as a beneficial tool to predict 90-day mortality in HBV-ACLF patients.

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Prediction and Risk Factors for Prognosis of Cirrhotic Patients with Hepatic Encephalopathy

Cited by 11 publications

References 29 publications

Validation of prognostic scores predicting mortality in acute liver decompensation or acute-on-chronic liver failure: A Thailand multicenter study

Validation of prognostic scores predicting mortality in acute liver decompensation or acute-on-chronic liver failure: A Thailand multicenter study

General Anesthesia in Patients with Hepatic Encephalopathy and Acute Variceal Bleeding Undergoing Endoscopic Treatment: A Retrospective Study

A novel nomogram to predict 90-day mortality in patients with hepatitis B virus-related acute-on-chronic liver failure: a single-center retrospective study

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