Prognostic significance of hepatic encephalopathy in patients with cirrhosis treated with current standards of care

Bohra, Anuj; Worland, Thomas; Hui, Samuel; Terbah, Ryma; Farrell, Ann; Robertson, Marcus

doi:10.3748/wjg.v26.i18.2221

Cited by 30 publications

(29 citation statements)

References 28 publications

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“…This study proves that ascites, which is a manifestation of portal hypertension, is associated with the incidence of HE. These results are consistent with studies by Bohra et al that HE occurs in patients with advanced cirrhosis, decompensation, and portal hypertension, and the most common precipitating factors are infection, gastrointestinal bleeding, constipation, non-adherence to medication, and electrolyte imbalance (16). A study by Tapper et al in 2019 found that two factors which most strongly associated with HE were alcohol-related liver cirrhosis and the presence of portal hypertension (17).…”

Section: Discussionsupporting

confidence: 90%

Correlation between Ascites and Total Lymphocyte Count with Occurrence of Hepatic Encephalopathy in Liver Cirrhosis Patients

Pravitasari¹

2021

JKB

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Hepatic encephalopathy (HE) is brain dysfunction manifested as a broad spectrum of neuropsychiatric abnormalities caused by hepatic insufficiency or portosystemic shunting due to portal hypertension. Portal hypertension in liver cirrhosis also causes ascites, as the most common clinical manifestation. Further, immune dysfunction, one of which is decreased total lymphocyte count (TLC), happens at liver cirrhosis, which triggers the systemic inflammatory response. This systemic inflammatory response plays a role in HE. Objective of this study is to know the correlation between ascites and TLC with occurence of HE in liver cirrhosis patient. This study was conducted by retrospective cohort design in Saiful Anwar Hospital. Determination of sample amount at this study used total sampling method. Hepatic encephalopathy diagnosis was based on West Haven Criteria. Ascites was determined by physical examination and/or abdominal ultasonography. Total lymphocyte count data was taken from medical record, with complete blood count examination used XS-800i hematology analyzer machine. Data were analyzed using a logistic regression test, with p<0.05 was considered significant and Confidence Interval (CI) 95%. Seventy-eight liver cirrhosis patients were observed using a retrospective cohort method regarding the HE occurrence, and physical examination for ascites and laboratory examination were performed. The statistical analysis result of the correlation between ascites and HE is significant with an odds ratio of 5.108 and CI of 1.36-19.25. On the other hand, TLC has no significant correlation with the occurrence of HE. Based on this analysis result, it is concluded that ascites has a correlation with HE, but TLC does not.<p> </p>

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Section: Discussionsupporting

confidence: 90%

Correlation between Ascites and Total Lymphocyte Count with Occurrence of Hepatic Encephalopathy in Liver Cirrhosis Patients

Pravitasari¹

2021

JKB

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“…In the current study by Bohra et al [ 1 ], the authors concluded that the use of Rifaximin failed to have prognostic impact on the outcomes of patients with decompensated liver disease. The probability of survival at 12 mo was 44% for the entire cohort, seemingly no different to the survival figures from studies in the ‘pre-rifaximin era’[ 5 ].…”

Section: To the Editormentioning

confidence: 75%

“…We read with interest this retrospective study by Bohra et al [ 1 ]. We thank the authors for sharing their real-life data in which they looked into the natural history of patients presenting to the gastroenterology inpatient service with refractory/recurrent hepatic encephalopathy (HE) and use of Rifaximin.…”

Section: To the Editormentioning

confidence: 99%

Letter to editor ‘prognostic significance of hepatic encephalopathy in patients with cirrhosis treated with Rifaxamin’

Elzubeir

Alam

2020

WJG

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The present letter to editor is related to Bohra A et al Prognostic significance of hepatic encephalopathy in patients with cirrhosis treated with current standards of care. World J Gastroenterol 2020; 26(18): 2221-2231. Hepatic encephalopathy (HE) is a significant and frequent major decompensating event in cirrhosis. However clinical studies examining the clinical outcome of HE are lacking despite its high prevalence.

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“…Covert HE is the preclinical stage of overt HE and refers to cognitive dysfunction (such as difficulty in decision-making and psychomotor slowing) without disorientation [5] while overt HE (OHE) is the presence of symptoms such as confusion, dysarthria, stupor, and coma. The development of OHE is a poor prognostic sign in the setting of chronic liver disease with the probability of survival of 44% at 1 year [6]. In the setting of acute liver failure, the development of HE is a harbinger of progressive hepatic failure.…”

Section: Introductionmentioning

confidence: 99%

Identifying areas of improvement in nursing knowledge regarding hepatic encephalopathy management

Sohal

Green

Sandhu

et al. 2021

Journal of Community Hospital Internal Medicine Perspectives

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Hepatic encephalopathy (HE) is a reversible brain dysfunction caused by liver insufficiency and portosystemic shunting. Hepatic encephalopathy is a common complication of advanced liver disease and is on a rise with the increasing incidence of non-alcoholic steatohepatitis (NASH). Since partnership with nursing staff is a critical part of successful management of these complex patients, we conducted a survey assessing their knowledge regarding HE.169 nurses participated in the survey. We found that more than 30% of the nurses did not know that ammonia is one of the toxins responsible for causing hepatic encephalopathy. We also found that 20% of the nurses had difficulty answering questions regarding titration of lactulose to bowel movements. Dietary education is a significant area for improvement as 80% of the nurses wanted to restrict fat and carbohydrate intake in these patients. With this simple survey, we identified important knowledge gaps among experienced nurses at our institution. We believe that by improving knowledge through focused lectures, we can improve patient care and reduce the length of hospitalizations in patients with HE.

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Prognostic significance of hepatic encephalopathy in patients with cirrhosis treated with current standards of care

Cited by 30 publications

References 28 publications

Correlation between Ascites and Total Lymphocyte Count with Occurrence of Hepatic Encephalopathy in Liver Cirrhosis Patients

Correlation between Ascites and Total Lymphocyte Count with Occurrence of Hepatic Encephalopathy in Liver Cirrhosis Patients

Letter to editor ‘prognostic significance of hepatic encephalopathy in patients with cirrhosis treated with Rifaxamin’

Identifying areas of improvement in nursing knowledge regarding hepatic encephalopathy management

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