Hepatic Encephalopathy in Patients with Cirrhosis

Frcp, Marsha Y. Morgan

doi:10.1002/9781444341294.ch8

Cited by 5 publications

(5 citation statements)

References 174 publications

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“…Thus, the results of this study could indirectly indicate that hepatic encephalopathy at diagnosis affects the prognosis of patients mainly by causing abnormalities in the portal blood flow. In patients with cirrhosis, portal‐systemic shunting is considered one of the key mechanisms in the development of hepatic encephalopathy 19,20 …”

Section: Discussionmentioning

confidence: 99%

Prognostic factors in patients with idiopathic portal hypertension: Two Japanese nationwide epidemiological surveys in 1999 and 2005

Murai

Ohfuji

Fukushima

et al. 2012

Hepatology Research

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Section: Discussionmentioning

confidence: 99%

Prognostic factors in patients with idiopathic portal hypertension: Two Japanese nationwide epidemiological surveys in 1999 and 2005

Murai

Ohfuji

Fukushima

et al. 2012

Hepatology Research

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“…The DST results were measured as points; those of the NCT-A, NCT-B, and SDT were measured as seconds. The line tracing test results were measured as both time to complete (LTTt, second) and as an error score (LTTe), as described previously [ 20 , 21 ], and LTT was defined as sum of LTTt and LTTe. The PHES procedure was repeated in a 30 sub-sample randomly selected from healthy volunteers at 4 weeks after the initial tests.…”

Section: Methodsmentioning

confidence: 99%

Detecting Minimal Hepatic Encephalopathy in an Endemic Country for Hepatitis B: The Role of Psychometrics and Serum IL-6

et al. 2015

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Background & AimsIt remains unknown what the prevalence of minimal hepatic encephalopathy is in Taiwan, a highly endemic country for chronic viral hepatitis infection. It is also unclear whether abnormal serum cytokine levels can be indicative of the presence of minimal hepatic encephalopathy. We aimed to standardize the tests of psychometric hepatic encephalopathy score and predictive value of proinflammatory cytokines in minimal hepatic encephalopathy in Taiwan.Methods180 healthy subjects and 94 cirrhotic patients without a history of overt hepatic encephalopathy from a tertiary center were invited to participate in this cross-sectional study. Blood sampling for determination of serum levels of interleukin 6 and 18 and tumor necrosis factor-α was performed. Based on the normogram of psychometric hepatic encephalopathy score from healthy volunteers, patients with minimal hepatic encephalopathy were identified from the cirrhotic patients using the criterion of a psychometric hepatic encephalopathy score less than −4.ResultsIn the healthy subjects, age and education were predictors of subtests of psychometric hepatic encephalopathy score. Minimal hepatic encephalopathy was identified in 27 (29%) cirrhotic patients. Serum interleukin 6 level (OR = 6.50, 95% CI = 1.64–25.76, P = 0.008) was predictive of the presence of minimal hepatic encephalopathy after multivariate analysis.ConclusionsThe psychometric hepatic encephalopathy score can be a useful tool for detecting patients with minimal hepatic encephalopathy in Taiwan and around one third of cirrhotic outpatients fulfill this diagnosis. A high serum interleukin 6 level is predictive of the presence of minimal hepatic encephalopathy.

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“…Descriptions of five HE health states (i.e. Conn grade 0, Conn grade 1, Conn grade 2, Conn grade 3 and Conn grade 4) were developed in collaboration with clinicians using published literature [ 4 , 8 , 21 , 22 ]. Each health state described the typical patient experience across several domains including symptoms, treatment, response, management and prognosis, enabling a balanced description across all five health states.…”

Section: Methodsmentioning

confidence: 99%

“…Grade 3 represents somnolence to semi stupor but responsive to verbal stimuli, confusion, gross disorientation. Grade 4 represents coma (unresponsive to verbal or noxious stimuli) [ 2 - 4 ]. Approximately 70% of patients with liver cirrhosis present with subclinical or mild HE, and 23-40% progress to a more severe form of the disease [ 5 - 7 ].…”

Section: Introductionmentioning

confidence: 99%

Utility values for specific hepatic encephalopathy health states elicited from the general public in the United Kingdom

Guest

Nanuwa

Barden

2014

Health and Quality of Life Outcomes

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Background and aimsTo elicit utility values for five health states corresponding to increasing severity of hepatic encephalopathy, from members of the general public in the UK. The health states studied were Conn grades 0, 1, 2, 3 and 4.MethodsInterviewer-administered time trade-off (TTO) and standard gamble (SG) utilities were elicited for the five health states from a random sample of 200 members of the general public in the UK, using health state descriptions validated by clinicians and members of the general public.ResultsRespondents’ mean age was 49.5 years and 49% were female. Mean utilities were 0.962 (TTO) and 0.915 (SG) for Conn grade 0; 0.912 (TTO) and 0.837 (SG) for Conn grade 1; 0.828 (TTO) and 0.683 (SG) for Conn grade 2; 0.691 (TTO) and 0.489 (SG) for Conn grade 3; and 0.429 (TTO) and 0.215 (SG) for Conn grade 4. The TTO and SG values between the five Conn grades were significantly different (p < 0.001). Additionally, the TTO value was significantly higher than the SG value for the corresponding state (p <0.0001).ConclusionThese findings quantify how different Conn grades and level of response to treatment may impact on the health-related quality of life of patients with hepatic encephalopathy. There were greater preference values for lower levels of disease, with the highest value associated with Conn grade 0. These health state preference values can be used to estimate the outcomes of different interventions for hepatic encephalopathy in terms of quality-adjusted life years.

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Hepatic Encephalopathy in Patients with Cirrhosis

Cited by 5 publications

References 174 publications

Prognostic factors in patients with idiopathic portal hypertension: Two Japanese nationwide epidemiological surveys in 1999 and 2005

Prognostic factors in patients with idiopathic portal hypertension: Two Japanese nationwide epidemiological surveys in 1999 and 2005

Detecting Minimal Hepatic Encephalopathy in an Endemic Country for Hepatitis B: The Role of Psychometrics and Serum IL-6

Utility values for specific hepatic encephalopathy health states elicited from the general public in the United Kingdom

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