Low phase angle is associated with the development of hepatic encephalopathy in patients with cirrhosis

Abstract

Aim: Evaluate the association between phase angle and the development of hepatic encephalopathy in the long-term follow-up of cirrhotic patients.

Methods: This was a prospective cohort study. Clinical, nutritional and biochemical evaluations were performed. Mann-Whitney's U and χ² tests were used as appropriate. Kaplan-Meier curves and Cox proportional Hazards analysis were used to evaluate the prediction and incidence of hepatic encephalopathy.

Results: Two hundred and twenty were included; the most frequent etiology of cirrhosis was hepatitis C infection, 52% of the patients developed hepatic encephalopathy (18.6% covert and 33.3% overt); the main precipitating factors were infections and variceal bleeding. Kaplan-Meier curves showed a higher proportion of HE in the group with low phase angle (39%) compared to the normal phase angle group (13%) (P = 0.012). Furthermore, creatinine and phase angle remained independently associated to hepatic encephalopathy in the Cox regression multivariate analysis [hazard ratio = 1.80 (1.07-3.03)].

Conclusion: In our cohort of patients low phase angle was associated with an increased incidence of hepatic encephalopathy. Phase angle is a useful nutritional marker that evaluates cachexia and could be used as a part of the integral assessment in patients with cirrhosis.

Keywords: Cachexia; Hepatic encephalopathy; Malnutrition; Phase angle; Prognosis.

Figure 1

Development of hepatic encephalopathy according to phase angle during the follow-up period of 48 mo (P = 0.012). PhA: Phase angle.

Figure 2

Precipitating factors of hepatic encephalopathy in the cohort. SBP: Spontaneous bacterial peritonitis; VB: Variceal bleeding.