A Model For Predicting Development of Overt Hepatic Encephalopathy in Patients With Cirrhosis (original) (raw)
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Hepatology (Baltimore, Md.), 2017
Over 40% of patients with cirrhosis will develop hepatic encephalopathy (HE). HE is associated with decreased survival, falls, motor vehicle accidents, and frequent hospitalization. Accordingly, we aimed to develop a tool to risk-stratify patients for HE development. We studied a population-based cohort of all patients with cirrhosis without baseline HE (N=1,979) from the Veterans Administration from Michigan, Indiana, and Ohio (1/1/2005-12/31/10) using demographic, clinical, laboratory, and pharmacy data. The primary outcome was the development of HE. Risk-scores were constructed with both baseline and longitudinal data (annually updated parameters) and validated using bootstrapping. The cohort had mean age of 58.0±8.3 years, 36% had hepatitis C, 17% had ascites. Opiates, benzodiazepines, statins, and nonselective beta-blockers were taken at baseline by 24%, 13%, 17%, and 12%. Overall, 863(43.7%) developed HE within 5 years. In multivariable models, risk factors (HR, 95%CI) for HE ...
A New Look at Precipitants of Overt Hepatic Encephalopathy in Cirrhosis
Digestive diseases and sciences, 2017
Overt hepatic encephalopathy (HE) is a major cause of significant morbidity and mortality in patients with liver cirrhosis. We examined the frequency and profile of the precipitating factors resulting in hospitalizations for overt HE. We conducted both retrospective and prospective studies to identify clinical precipitants of overt HE in patients with cirrhosis. The retrospective study patients were hospitalized at a large urban safety-net hospital, and the prospective study included the patients admitted at a liver transplant center. There were a total of 149 patients with cirrhosis and overt HE (91 males, mean age 55.3 ± 8.6 years) in the retrospective group and 45 patients (27 males, mean age 58.3 ± 8.2 years) in the prospective group of the study. The average MELD score was 16 ± 6.8 in the retrospective group and 22.7 ± 7.2 in the prospective group. Dehydration (46-76%), acute kidney injury (32-76%), lactulose nonadherence (about 50%), constipation (about 40%), and infections (2...
Prognostic significance of hepatic encephalopathy in patients with cirrhosis
Journal of Hepatology, 1999
There are numerous studies concerning the natural history and prognostic factors in cirrhosis, the results of which are useful in selecting liver transplant candidates. However, little attention has been paid to the prognostic significance of hepatic encephalopathy despite the high frequency of this complication. Methods: We reviewed the charts of Ill cirrhotic patients who developed a first episode of acute hepatic encephalopathy to determine their survival probability and to identify prognostic factors. Results: During follow-up (12st17 months), 82 (74%) patients died. The survival probability was 42% at 1 year of follow-up and 23% at 3 years. With univariate analyses followed by a multivariate analysis, 7 out of 30 clinical and standard laboratory variables were significantly associated with poor prognosis: male sex, increased serum bilirubin, alkaline phosphatase, potassium and blood urea nitrogen, and decreased serum
Precipitating Factors and Treatment Outcomes of Hepatic Encephalopathy in Liver Cirrhosis
Cureus, 2019
Background Hepatic encephalopathy (HE) is a common cause of hospital admission in patients with liver cirrhosis (LC). The aims of this study were to evaluate the precipitant factors and analyze the treatment outcomes of HE in LC. Methods All the LC patients admitted between February 2017 and January 2018 for overt HE were analyzed for precipitating factors and treatment outcomes. Treatments were compared among three treatment groups: receiving lactulose, lactulose plus L-ornithine L-aspartate (LOLA), and lactulose plus rifaximin. The primary endpoints were mortality and hospital stay. The chisquare test was used to compare the different treatment outcomes with hospital stay and mortality with significance at p<0.05.
Zagazig University Medical Journal, 2020
Background: Minimal hepatic encephalopathy (MHE) has a mild neurocognitive impairment that includes neuropsychological and neurophysiological alterations that can not be detected by clinical examination. This study aims to assess the frequency and risk factors for developing minimal hepatic encephalopathy in patients with compensated cirrhosis. Methods: This cross sectional study was conducted on 60 patients with compensated cirrhosis in Zagazig University Hospital and elmatarya Teaching Hospital from December 2017 to June 2018, diagnosis of minimal hepatic encephalopathy was established by using mini mental status examination test and psychometric studies, they underwent full history, laboratory investigations and abdominal doppler ultrasonography by professional radiologist assessing the presence of any porto systemic shunts and measuring serum ammonia level. Results: About 37% had MHE. Female represented 65% with mean age 49.82 years. There is statistically significant relation between MHE and smoking, comorbid diabetes, hypertension, high ammonia level and portosystemic shunt. Smoking, being single, illiterate, portosystemic shunt, comorbid diabetes and hypertension increased risk of MHE by 4.57, 3.05, 2.31, 25.94, 3.29 and 3.55 folds. Male gender and normal ammonia level were protective factors. There is significant relation between MHE and age, platelet count, serum albumin, ammonia and INR. Older patients, low platelet count and serum albumin, high ammonia level and INR were detected among patients with MHE. Increasing ammonia level was significant independent risk factor for MHE. Conclusions: MHE is a prevalent condition among patients with compensated cirrhosis with high ammonia level and portosystemic shunts as a strong risk factors for its development.
Clinical Therapeutics, 2013
Background: Hepatic encephalopathy (HE), which may be categorized as minimal or overt, is a serious and progressive neuropsychiatric condition that occurs in patients with liver disease or portosystemic shunting. Overt HE (OHE) presents as a wide spectrum of clinical signs and symptoms, ranging in severity from mild confusion to life-threatening coma. Minimal HE (MHE) is a more subtle form of the condition; it is characterized by deficits in cognitive function in patients with a normal clinical examination.
Hepatology Research, 2013
Aim: Minimal hepatic encephalopathy (MHE) affects more than 30% of patients with cirrhosis, and it has been suggested that despite no recognizable clinical symptoms of neurological abnormalities, it may affect health-related quality of life (HRQL); however, this fact remains controversial. The aim of our study was to evaluate the prevalence of MHE and HRQL in patients diagnosed with decompensated cirrhosis.
Predicting in-hospital mortality of cirrhotic patients hospitalized with hepatic encephalopathy
Egyptian Liver Journal, 2022
Background Hepatic encephalopathy (HE) is a serious condition associated with high rates of mortality. Many scoring systems are used to predict the outcome of HE in patients admitted to the intensive care unit (ICU). The most used scores are Child-Turcotte-Pugh (CTP), Model for End-stage Liver Disease (MELD), Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA), and Acute Physiology and Chronic Health Evaluation II (APACHE II). These scores were thoroughly investigated in HE associated with acute liver failure (type A). In the present study, we aimed to evaluate the prognostic value of these scores in patients with HE on a background of liver cirrhosis (type C). Two hundred cirrhotic patients hospitalized with HE were included in the study. Diagnosis and classification of HE were based on the West Haven criteria. APACHE II, CLIF-SOFA, MELD, MELD-Na, and CTP scores were calculated for all patients within the first 24 h after admission. According to survival outcomes,...
Predictors of treatment response in cirrhotic patients with overt hepatic encephalopathy
Journal of Patan Academy of Health Sciences
Introduction: Hepatic encephalopathy (HE) is a frequent complication and one of the most debilitating manifestations of liver cirrhosis, which negatively impacts patient survival. This study aims to identify the factors influencing the treatment response in patients with liver cirrhosis and HE. Method: This was a prospective observational study conducted from July 2019 to June 2020 in a tertiary referral center of Nepal. The ethical clearance was obtained from the Institutional Review Board of the center (Reference No. 46/076/77). Patients with Liver cirrhosis with HE grade II or more were included. Standard medical therapy for HE was given to all the patients, and treatment response for the first five days post admission was recorded. The response was categorized as good response, no response and deterioration, based on improvement or deterioration of patient`s symptoms or changes in West Haven criteria. Result: In this study total 78 patients were enrolled and included in the fina...
Hepatic Encephalopathy in Liver Cirrhosis: Precipitating factor and Outcome
Journal of Nepalgunj Medical College, 2019
Introduction: Hepatic encephalopathy, one of the major decompensating events of liver cirrhosis manifest as a wide spectrum of neurological or psychiatric abnormalities ranging from subclinical alterations to coma. The main aim of this study was to determine precipitants of hepatic encephalopathy (HE) and their impact on hospital stay and mortality. Methods: A hospital based cross-sectional study carried out in the Department of Medicine, Nepalgunj Medical College, Kohalpur from September 2018 to May 2019. Patients of liver cirrhosis with signs and symptoms of hepatic encephalopathy (HE) were enrolled in the study. Detailed history was taken with patients or patient's visitor regarding precipitating factors. Child Turcotte Pugh (CTP) class was used for assessing liver disease severity and West Haven classification was used for grading of hepatic encephalopathy. Results: Total patients of hepatic encephalopathy studied were 150. Among which, 114 (76%) were male and 36 (24%) were ...