Hepatic encephalopathy increases the risk for mortality and hospital readmission in decompensated cirrhotic patients: a prospective multicenter study

Abstract

IntroductionHepatic encephalopathy (HE) affects the survival and quality of life of patients with cirrhosis. However, longitudinal data on the clinical course after hospitalization for HE are lacking. The aim was to estimate mortality and risk for hospital readmission of cirrhotic patients hospitalized for HE.MethodsWe prospectively enrolled 112 consecutive cirrhotic patients hospitalized for HE (HE group) at 25 Italian referral centers. A cohort of 256 patients hospitalized for decompensated cirrhosis without HE served as controls (no HE group). After hospitalization for HE, patients were followed-up for 12 months until death or liver transplant (LT).ResultsDuring follow-up, 34 patients (30.4%) died and 15 patients (13.4%) underwent LT in the HE group, while 60 patients (23.4%) died and 50 patients (19.5%) underwent LT in the no HE group. In the whole cohort, age (HR 1.03, 95% CI 1.01–1.06), HE (HR 1.67, 95% CI 1.08–2.56), ascites (HR 2.56, 95% CI 1.55–4.23), and sodium levels (HR 0.94, 95% CI 0.90–0.99) were significant risk factors for mortality. In the HE group, ascites (HR 5.07, 95% CI 1.39–18.49) and BMI (HR 0.86, 95% CI 0.75–0.98) were risk factors for mortality, and HE recurrence was the first cause of hospital readmission.ConclusionIn patients hospitalized for decompensated cirrhosis, HE is an independent risk factor for mortality and the most common cause of hospital readmission compared with other decompensation events. Patients hospitalized for HE should be evaluated as candidates for LT.

Episodic overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt does not increase mortality in patients with cirrhosis

“…The main finding of this large non-inferiority study, which included 614 patients with cirrhosis undergoing elective TIPS, is that the development of episodic OHE after TIPS is not associated with an increased risk of mortality, unlike in patients with cirrhosis not undergoing TIPS. 25,36 Remarkably, there was no excess of mortality even when the population was separately analyzed according to TIPS indication, i.e. prevention of re-bleeding or refractory ascites.…”

“…The finding that patients with cirrhosis who develop post-TIPS OHE have similar mortality rates compared to patients without OHE is somehow surprising considering data previously reported in patients with cirrhosis without TIPS, where OHE was associated with higher mortality. 25,36 One hypothesis that can be put forward to explain this result is that patients who underwent TIPS placement at our centers had been strictly selected and those with severe hepatic failure were excluded. Moreover, all patients were closely monitored, given the potential for complications.…”

Rifaximin Reduces Risk of All-Cause Hospitalization in Cirrhotic Liver Transplant Candidates with Hepatic Encephalopathy

“…In fact, although LT represents the best treatment for decompensated cirrhosis, not all cirrhotic patients on the waiting list reach LT, due to complications of cirrhosis, including HE, most of which require hospitalization [21][22][23]. However, a negative effect of hospitalizations for HE on the survival of cirrhotic patients both before and after LT has been demonstrated [24][25][26][27][28][29][30]. In this retrospective study, we analyzed the impact of rifaximin treatment on the risk of first hospitalization, and on dropout for worsening or death in patients on the LT waiting list.…”