Prognosis and 1-year mortality of intensive care unit patients with severe hepatic encephalopathy

Fichet, Jérôme; Mercier, Emmanuelle; Genée, Olivier; Garot, Denis; Legras, Annick; Dequin, Pierre‐François; Perrotin, D.

doi:10.1016/j.jcrc.2009.01.008

Cited by 109 publications

(82 citation statements)

References 27 publications

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“…The prognosis of patients admitted in the ICU for hepatic encephalopathy varies according to the presence or absence of other organ failure. A recent study has shown the in-patient mortality rate of cirrhotic patients admitted in the ICU with encephalopathy was approximately 10% in those with isolated encephalopathy compared with more than 80% in those with encephalopathy plus failures of other organs [82]. Aspiration pneumonia and acute respiratory failure represent the most severe consequences of encephalopathy, indicating that airway protection is an absolute priority in advanced encephalopathy.…”

Section: Brainmentioning

confidence: 99%

Acute-on-chronic liver failure: current concepts on definition, pathogenesis, clinical manifestations and potential therapeutic interventions

Laleman

Verbeke

Meersseman

et al. 2011

Expert Review of Gastroenterology & Hepatology

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Section: Brainmentioning

confidence: 99%

Acute-on-chronic liver failure: current concepts on definition, pathogenesis, clinical manifestations and potential therapeutic interventions

Laleman

Verbeke

Meersseman

et al. 2011

Expert Review of Gastroenterology & Hepatology

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“…Based on comparison with other complications of cirrhosis, the mortality rates are comparable to bleeding from varices [13] . OHE has been associated with 54% mortality at one year in patients needing admission to intensive care unit [14] , while data from the inpatient samples report a 14% to 15% mortality over the 5year period [5] . Jepsen et al [9] describe 169 patients with a median survival time of 2.4 mo from disease onset with mortality rates of 45% within 1 mo, 64% within 1 year, and 85% within 5 years.…”

Section: Associated With Hementioning

confidence: 99%

Advances in cirrhosis: Optimizing the management of hepatic encephalopathy

Liu

Perumpail

Kumari

et al. 2015

WJH

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Hepatic encephalopathy (HE) is a major complication of cirrhosis resulting in significant socioeconomic burden, morbidity, and mortality. HE can be further subdivided into covert HE (CHE) and overt HE (OHE). CHE is a subclinical, less severe manifestation of HE and requires psychometric testing for diagnosis. Due to the time consuming screening process and lack of standardized diagnostic criteria, CHE is frequently underdiagnosed despite its recognized role as a precursor to OHE. Screening for CHE with the availability of the Stroop test has provided a pragmatic method to promptly diagnose CHE. Management of acute OHE involves institution of lactulose, the preferred first-line therapy. In addition, prompt recognition and treatment of precipitating factors is critical as it may result in complete resolution of acute episodes of OHE. Treatment goals include improvement of daily functioning, evaluation for liver transplantation, and prevention of OHE recurrence. For secondary prophylaxis, intolerance to indefinite lactulose therapy may lead to non-adherence and has been identified as a precipitating factor for recurrent OHE. Rifaximin is an effective add-on therapy to lactulose for treatment and prevention of recurrent OHE. Recent studies have demonstrated comparable efficacy of probiotic therapy to lactulose use in both primary prophylaxis and secondary prophylaxis.

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“…Once patients with cirrhosis develop MHE, they are at a substantial risk of progression to OHE, resulting in a significant burden to the healthcare system and an increased risk of mortality. 64,65 Studies have consistently shown that patients with MHE have a diminished quality of life, cognitive function, daily function, and driving impairment. [3][4][5][6][7][8][9][10] While it was once thought that cognitive impairment with CHE or OHE was reversible, data from studies evaluating medical treatment or liver transplantation suggest that the associated cognitive changes may not be totally reversible.…”

Section: Management Guidelines For Covert Hepatic Encephalopathymentioning

confidence: 99%

Management of Covert Hepatic Encephalopathy

Waghray

Mullen

2015

Journal of Clinical and Experimental Hepatology

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Hepatic encephalopathy is a reversible progressive neuropsychiatric disorder that encompasses a wide clinical spectrum. Covert hepatic encephalopathy is defined as patients with minimal hepatic encephalopathy and Grade I encephalopathy by West-Haven Criteria. Terminology such as "sub-clinical", "latent", and "minimal" appear to trivialize the disease and have been replaced by the term covert. The lack of clinical signs means that covert hepatic encephalopathy is rarely recognized or treated outside of clinical trials with options for therapy based on patients with episodic hepatic encephalopathy. This review discusses the current available options for therapy in covert hepatic encephalopathy and focuses on non-absorbable disacharides (lactulose or lactitol), antibiotics (rifaximin), probiotics/synbiotics and L-ornithine-L-aspartate. ( J CLIN EXP HEPATOL 2015;5:S75-S81)

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Prognosis and 1-year mortality of intensive care unit patients with severe hepatic encephalopathy

Cited by 109 publications

References 27 publications

Acute-on-chronic liver failure: current concepts on definition, pathogenesis, clinical manifestations and potential therapeutic interventions

Acute-on-chronic liver failure: current concepts on definition, pathogenesis, clinical manifestations and potential therapeutic interventions

Advances in cirrhosis: Optimizing the management of hepatic encephalopathy

Management of Covert Hepatic Encephalopathy

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