Exacerbation of hepatic cirrhosis may trigger admission for epilepsy and status epilepticus

Abstract

Objective To determine whether acute exacerbations of cirrhotic liver disease are associated with higher odds of readmission for epilepsy or status epilepticus. Methods The New York State Inpatient Database is a statewide dataset containing data on 97% of hospitalizations for New York State. In this retrospective, case‐crossover design study, we used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify index status epilepticus and epilepsy admissions. The primary exposure was defined as admission due to an acute exacerbation of cirrhotic liver disease. The case‐crossover analysis tested whether exposure to a hepatic exacerbation within progressively longer case periods (14, 30, 60, 90, 120, 150, and 180 days before index admission), compared to control periods 1 year before the case period, was associated with readmission for epilepsy or status epilepticus. Results The odds ratio for subsequent admission for epilepsy after exposure to an acute exacerbation of cirrhotic liver disease was significant in the 30‐day window at 2.072 (95% confidence interval [CI] = 1.095‐3.92, P = .0252) and peaked in the 150‐day window at 2.742 (95% CI = 1.817‐4.137, P < .0001). In the status epilepticus group, all case periods demonstrated significantly elevated odds of subsequent admission following hepatic exacerbation. Significance Hepatic exacerbations are associated with increased odds for hospital admissions for epilepsy and status epilepticus across several timeframes.

Non-Convulsive Status Epilepticus in Hepatic Encephalopathy: A Case Series and Review of the Literature

“…A high level of clinical suspicion is required to identify NCSE that is associated with elevated mortality [ 5 ] . Gursky et al showed that HE events were associated with subsequent admissions for epilepsy or SE [ 14 ] . This effect was even higher for admission with SE, with a three- to fivefold likelihood of admission with SE in the next 6 months [ 14 ] .…”

“…Gursky et al showed that HE events were associated with subsequent admissions for epilepsy or SE [14] . This effect was even higher for admission with SE, with a three-to fivefold likelihood of admission with SE in the next 6 months [14] . Table 1 summarizes the four case reports found in PubMed, CINAHL and Web of Science [15][16][17][18] .…”