Adherence to Recommended Inpatient Hepatic Encephalopathy Workup

Abstract

Hepatic encephalopathy (HE) is characterized by altered sensorium and is the most common indication for hospitalization among patients with cirrhosis. Liver societal guidelines for inpatient HE revolve around identification of potential precipitants. In this retrospective study, we aimed to determine adherence to societal guidelines for evaluation of HE in 78 inpatients. The adherence rate to societal recommended guidelines for workup of HE was low, with only 17 (22%) patients having complete diagnostic workup within 24 hours of admission. Notably, 23 (30%) patients were not subjected to blood culture analysis, 16 (21%) were missing urinalysis, and 15 (20%) were missing chest radiograph. In patients with ascites (N = 34), 26 (77%) did not have a diagnostic paracentesis to exclude spontaneous bacterial peritonitis. In contrast, serum ammonia determination, a laboratory test not endorsed by societal guidelines for workup of HE, was ordered in 74 (95%) patients. These findings underscore the limited adherence to societal guidelines in hospitalized patients with HE.

Adherence to quality indicators and hospital outcomes for patients with decompensated cirrhosis: An observational study

“…Our findings are consistent with other studies that have found variable adherence to QIs in cirrhosis care (8,15,16,17). Care for HE and SBP had particularly low QI adherence as opposed to QI adherence for VB.…”

Liquid Diagnosis of Hepatic Encephalopathy: Are We There Already?

“…Ammonia is a serum biomarker that 60–95% of clinicians use in their practice to diagnose HE [4], although studies show, that in the context of CLD, ammonia determination does not seem to change the management of the patient, nor provides prognostic information [5]. Joint European and American guidelines state, however, that in a patient with OHE, a normal blood ammonia level should raise the suspicion of an alternative diagnosis [1].…”

The role of the hospitalist in the continuum of care for patients with hepatic encephalopathy: treatment of inpatient episodes and preventing outpatient recurrence and readmissions

“…There is no specific biochemical diagnostic test for HE, but a complete laboratory evaluation can help to exclude other factors and/or causes. Serum NH3 levels are rarely useful, as the levels do not correlate with symptoms and do not change practice (1,38). While the positive predictive value is poor, a low serum NH3 in a confused patient likely indicates the absence of HE (1).…”