Serial assessment of hepatic encephalopathy in patients hospitalised for acute decompensation of cirrhosis

Maggi, Dariana; Borgonovo, Ariane; Bansho, Emilia Tiemi Oshiro; Soares-Silva, Pedro E.; Silva, Telma E.; Colombo, Bruno S.; Wildner, Letícia Muraro; Bazzo, Maria Luiza; Dantas-Corrêa, Esther Buzaglo; Narciso-Schiavon, Janaína Luz; Schiavon, Leonardo Lucca

doi:10.1016/j.aohep.2018.11.002

Cited by 5 publications

(4 citation statements)

References 26 publications

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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][37][38]. Further study with a larger sample size may be needed.…”

Section: Plos Onementioning

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: Plos Onementioning

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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“…Model for End‐Stage Liver Disease (MELD) 29 was calculated based on laboratory tests and clinical evaluation performed at admission, and EASL‐CLIF criteria were used to determine the presence of organ failures and grade of ACLF 30 . The West Haven (WH) classification was used to assess the severity of HE 31,32 . Patients admitted for reasons other than AD or with severe comorbidity, pregnancy, malignancy, infection with HIV and history of surgery were excluded.…”

Section: Methodsmentioning

confidence: 99%

“…30 The West Haven (WH) classification was used to assess the severity of HE. 31,32 Patients admitted for reasons other than AD or with severe comorbidity, pregnancy, malignancy, infection with HIV and history of surgery were excluded.…”

Section: Patientsmentioning

confidence: 99%

Overt hepatic encephalopathy is an independent risk factor for de novo infection in cirrhotic patients with acute decompensation

Alabsawy

Shalimar

Sheikh

et al. 2022

Aliment Pharmacol Ther

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Background:The occurrence of overt hepatic encephalopathy (OHE) is associated with increased mortality. HE is commonly precipitated by infection, but whether HE predisposes to new infection is unclear. This study aimed to test if OHE predisposes to de novo infection during hospitalisation and its association with short-term mortality.Aims and Methods: Seven hundred and fifty-nine consecutive patients were identified at two institutions from prospectively maintained clinical databases of cirrhotic patients admitted with acute decompensation (AD). Infection and HE data were collected on the day of admission, and the occurrence of de novo infections was assessed for 28 days after admission. EASL-CLIF organ failure criteria were used to determine the presence of organ failures. Multivariable analysis using the logistic regression model was used to assess predictors of 28-day mortality and de novo infection.Results: Patients were divided into four groups; no baseline OHE or infection (n = 352); OHE with no baseline Infection (n = 221); no OHE but baseline infection (n = 100) and OHE with baseline infection (n = 86). On multivariate analyses, OHE (OR, 1.532 [95% CI, 1.061-2.300, P = 0.024]), and admission to ITU (OR, 2.303 [95% CI, 1.508-3.517, P < 0.001]) were independent risk factors for de novo infection.28-day mortality was 25.3%, 60.2%, 55.0% and 72.1% in the 4-groups respectively.Age, INR and creatinine were independently predictive of mortality. The presence of overt HE, infection, coagulation, kidney, circulatory, respiratory and liver failures were significantly associated with higher mortality. Conclusion:OHE is an independent risk factor for de novo infection in cirrhotic patients with AD.

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“…Hepatic encephalopathy with an unfavorable outcome as per the West Haven criteria [25] is associated with higher short-term mortality (within 90 days) [26].…”

Section: Symptomatic Treatmentmentioning

confidence: 99%

Cirrhosis: Therapeutic Aspects and Outcome for Hospitalized Patients in Burkina Faso

Somé¹,

Nana²,

Lompo³

et al. 2021

OJEpi

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Introduction: Cirrhosis represents 27.63% of the hepatobiliary diseases in Burkina Faso. We aimed at studying the therapeutic and evolutionary features of the cirrhosis. Patients and methods: We implemented a cross-sectional and descriptive study, collecting retrospectively the data from 1st January 2012 to 31st March 2014. The diagnosis of cirrhosis was based on 1) clinical criteria (an edema-ascitic syndrome with a heterogeneous hepatomegaly with a sharp inferior border or atrophic liver and a portal hypertension); 2) biological criteria (a hepatocellular insufficiency syndrome); and 3) ultrasound imaging suggesting cirrhosis. Qualitative variables were presented as frequencies and percentages while quantitative ones were presented as means. Results: The data of 273 patients representing 33.9% of all hospitalizations were analyzed. The hepato-biliary diseases represented 74.7% of all diagnosis. The participants' mean age was 46.9 years and the sex ratio, 2.7. The HBs antigen and anti-HCV antibodies were positive in 76.5% and 14.6% of the cases, respectively. Ascites was treated with puncture in 40.2% of patients, a salt-free diet (38.8%) and diuretics (54.2%). Hepatic encephalopathy was treated with lactulose in 73.6% of patients and two patients (1.3%) underwent esophageal varices ligation to treat their gastrointestinal bleeding. Lamivudine, tenofovir, and lamivudine-tenofovir combination were administered to 57.4%, 32.8%, and 10% of HBs Antigen positive patients, respectively. Conclusion: Cirrhosis still mostly affects the young and active male population at the gastro-enterology department of the university teaching hospital Yalgado Ouédraogo. Patients show up at a very advanced stage of the disease in poorly prepared health centres. In this context, prevention by the anti-hepatitis B immunization and early systematic screening with treatment when indicated are very efficient weapons at our disposal.

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Serial assessment of hepatic encephalopathy in patients hospitalised for acute decompensation of cirrhosis

Cited by 5 publications

References 26 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

Overt hepatic encephalopathy is an independent risk factor for de novo infection in cirrhotic patients with acute decompensation

Cirrhosis: Therapeutic Aspects and Outcome for Hospitalized Patients in Burkina Faso

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