Prognostic significance of hepatic encephalopathy in patients with cirrhosis

Bustamante, Javier; Rimola, Antoni; Ventura, Pere Joan; Navasa, Miquel; Cirera, Isabel; Reggiardo, Virginia; Rodés, Juan

doi:10.1016/s0168-8278(99)80144-5

Cited by 503 publications

(334 citation statements)

References 23 publications

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“…In France, the mortality rate of HCC has been multiplied by 4. This is explained primarily by the conjunction of two factors: in one hand, a decrease in mortality due to other complications of cirrhosis (like spontaneous bacterial peritonitis and bleeding due to portal hypertension) and in the other hand an increase in frequency of HCC related to cirrhosis secondary to hepatitis C [37]. In our series, this complication was not identified as a predictor of intrahospital mortality in cirrhotic patients p = 0.370).…”

Section: Discussioncontrasting

confidence: 49%

Predictors of Intra-Hospital Mortality in Patients with Cirrhosis

Charif¹,

Saâda²,

Mellouki³

et al. 2014

OJGas

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Intra-hospital mortality in cirrhotic patients is variable depending on the studies reported in literature. Several studies have demonstrated independent predictors of mortality. The aim of this work is indeed to identify these predictors. Patients and Methods: We conducted a retrospective study of 1080 cirrhotic patients hospitalized in our department of gastroenterology and hepatology between January 2001 and August 2010. A descriptive study of the study population was performed, and a univariate analysis looking for an association between intra-hospital mortality, and clinical, biological, etiological and socio-demographic characteristics of our patients. Results: The average age of our patients was 54 years, with an equal number of men and women. 41.1% of patients had cirrhosis secondary to hepatitis C and 18.5% had cirrhosis secondary to hepatitis B. 26.1% of our patients were CHILD C. Intra-hospital mortality was 8.7% (97 deaths) with a mean of 23.4 ± 35.8 months. Univariate analysis showed that the intra-hospital mortality was significantly associated with higher age (p = 0.049) as well as the reasons for admissions like hepatic encephalopathy, and hematemesis (p < 0.0001), melena, jaundice and ascites (p = 0.001). Among the biological parameters analyzed in univariate analysis, significant associations with mortality were objectified for high white blood cell count (p = 0.035), and high serum bilirubin and creatinine (p < 0.0001); low rate of prothrombin time (PT) (p < 0.0001), of albumin (p = 0.0001) and of serum sodium (p < 0.0001). Among the complications analyzed, significant associations with mortality were objectified for jaundice, ascites (p = 0.001), hemorrhagic decompensation, hepatic encephalopathy, and spontaneous bacterial peritonitis (p < 0.001). Univariate analysis of the etiology of cirrhosis objectified significant associations for cirrhosis secondary to hepatitis B (p = 0.001) and hepatitis C (p = 0.022). Multivariate analysis objectified four independent predictors of mortality: hepatic encephalopathy, infection (hyper leukocytosis ≥ 10,000/mm 3 ), renal failure (serum creatinine ≥ 15 mg/l) and hyponatremia. Conclusion: In our series, we identified four independent predictors of intra-hospital mortality in cirrhotic patients: hepatic encephalopathy, infection, renal failure and hyponatremia.

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Section: Discussioncontrasting

confidence: 49%

Predictors of Intra-Hospital Mortality in Patients with Cirrhosis

Charif¹,

Saâda²,

Mellouki³

et al. 2014

OJGas

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“…4,5 Because of this, an additive liver damage caused by these three viruses is conceivable and would explain the effect of HDV on survival found in this study. HE as the first decompensation has also been found previously to have a strong impact on the survival of patients with cirrhosis, 29,30 including those harboring HCV-related cirrhosis. 25 In our study, HE was associated with a poorer outcome independently of the number of simultaneous events patients presented.…”

Section: Discussionmentioning

confidence: 75%

HIV coinfection shortens the survival of patients with hepatitis C virus-related decompensated cirrhosis

et al. 2005

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“…Encephalopathy, a common and potentially life-threatening complication of acute liver failure (ALF) [1,2], is predominantly a clinical diagnosis. Anatomical MRI frequently does not show abnormalities [3].…”

Section: Introductionmentioning

confidence: 99%

Quantitative multivoxel 1H MR spectroscopy of the brain in children with acute liver failure

et al. 2008

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Acute liver failure (ALF)-related encephalopathy was previously characterized by MR spectroscopy of single voxels containing both grey and white matter brain tissue. Quantitative multivoxel MRS was used here to compare grey and white matter brain tissue concentrations of glutamate/glutamine (Glx) and lactate in ALF and associate the results with other liver function parameters. Five pediatric patients with ALF-related encephalopathy and five controls, examined after successful liver transplantation, were examined by brain MRI/MRS. ALF patients had higher Glx and lactate concentrations in brain white matter than controls (Glx + 125%: P<0.01; lactate + 33%, P<0.05) and higher Glx in grey matter (Glx + 125%: P< 0.01). Within the group of ALF patients positive correlations were found between grey or white matter lactate concentration and serum ammonia (P<0.05), and negative correlations between grey or white matter Glx and venous pH (P<0.001). This is the first study presenting evidence of high Glx levels in both white and grey matter brain tissue in ALF-related encephalopathy. The elevations in CNS Glx and lactate concentrations appear to relate to hepatic detoxification (ammonia, venous pH), rather than to liver parenchymal integrity (aspartate aminotransferase, alanine aminotransferase) or biliary cholestasis (bilirubin, γ-glutamyl transpeptidase, alkaline phosphatase).

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Prognostic significance of hepatic encephalopathy in patients with cirrhosis

Cited by 503 publications

References 23 publications

Predictors of Intra-Hospital Mortality in Patients with Cirrhosis

Predictors of Intra-Hospital Mortality in Patients with Cirrhosis

HIV coinfection shortens the survival of patients with hepatitis C virus-related decompensated cirrhosis

Quantitative multivoxel 1H MR spectroscopy of the brain in children with acute liver failure

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