Risk of recurrent hepatic encephalopathy in patients with liver cirrhosis: a German registry study

Abstract

Background and aims Patients with hepatic encephalopathy (HE) show low quality of life, recurrent hospitalizations and an increased mortality. We aimed to assess the natural course of patients after a recent episode of overt HE and to identify risk factors for HE recurrence in Germany. Methods Fifteen sites took part in a prospective, observational study including patients with liver cirrhosis who had been hospitalized for HE within 3 months before recruitment. Clinical data, psychometric hepatic encephalopathy score (PHES) and critical flicker frequency were assessed quarterly for 1 year. Primary endpoint was HE recurrence requiring hospitalization, all-cause-mortality was treated as a competing risk factor. Results From January 2014 to March 2016, a total of 115 patients were recruited. Overall 14 premature deaths were documented. For 78 subjects follow-up data were available in accordance with the protocol. After a median of 118 days, more than half of the per-protocol cohort was readmitted to hospital due to HE (N = 34) or died (N = 11). The risk for hospitalization was significantly increased in patients who had been recruited by liver transplant centers (P = 0.003), had had frequent HE relapses prior to recruitment (P = <0.0001) or an abnormal PHES result of <−4 (P = 0.044). Abnormal PHES results barely missed level of significance as an independent risk factor for re-hospitalization in a multivariable competing risk model (P = 0.093). Conclusion Patients with a history of HE are at high risk for the development of recurrent overt HE demanding hospitalization. The PHES test may aid in detection, monitoring and risk stratification of recurrent HE.

Overt Hepatic Encephalopathy: Current Pharmacologic Treatments and Improving Clinical Outcomes

“…20 A small German study reported that 43.6% of 78 patients with a previous hepatic encephalopathy-related hospitalization were readmitted for hepatic encephalopathy; a history of ≥ 4 prior episodes of hepatic encephalopathy was identified as a risk factor for hepatic encephalopathy-related readmission (P < .001). 23 Hepatic Encephalopathy-Related Mortality. In contrast to data showing both increased admissions and readmissions for hepatic encephalopathy, [18][19][20][21]23 data from the NIS showed that in-hospital hepatic encephalopathy-related mortality, though substantial, has decreased significantly from 2009 to 2013 (11.9%-10.2%, respectively; P < .001).…”

“…23 Hepatic Encephalopathy-Related Mortality. In contrast to data showing both increased admissions and readmissions for hepatic encephalopathy, [18][19][20][21]23 data from the NIS showed that in-hospital hepatic encephalopathy-related mortality, though substantial, has decreased significantly from 2009 to 2013 (11.9%-10.2%, respectively; P < .001). 14 The mean length of hospitalization was also significantly reduced, from 7.5 days (2009) to 7.1 days (2013; P = .02).…”

Dosing of Rifaximin Soluble Solid Dispersion Tablets in Adults With Cirrhosis: 2 Randomized, Placebo-controlled Trials

“…There was no 11 ; thus, preventing complications is critical. Results of a previous study showed that 44% of patients with cirrhosis who developed OHE were rehospitalized within 1 year 12 ; further, survival rates decreased within a short time frame (42% survival at 1 year; 23% at 3 years). 13 The changes observed with rifaximin SSD IR 40 mg vs placebo might underscore the role of GI microbial modification in cirrhosis progression that may be agnostic of etiology.…”

“…Assessments. Efficacy and safety assessments were conducted at Day 1 (baseline) and Weeks 2,4,8,12,16,20, and 24 (end of treatment); all patients completed an end-of-study assessment at Week 26 (or time of early termination). The primary efficacy endpoint, per protocol, was time to hospitalization due to a cirrhosis-related complication (hepatic encephalopathy [HE], EVB, hepatorenal syndrome, or SBP) or all-cause mortality during 24 weeks of treatment; no interim analysis was performed.…”

Hepatic encephalopathy: Novel insights into classification, pathophysiology and therapy

“…The PHES consists of 5 paper-pencil tests evaluating cognitive/psychomotor processing speed and visuomotor coordination. They are relatively easy to administer, have good external validity and have been translated/validated into several languages and countries 251. Animal naming test (ANT)Neuropsychological, bed-side The ANT (i.e.…”