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Observational Study
. 2017 Sep 14;23(34):6321-6329.
doi: 10.3748/wjg.v23.i34.6321.

Natural history of covert hepatic encephalopathy: An observational study of 366 cirrhotic patients

An-Jiang Wang  1 , A-Ping Peng  1 , Bi-Min Li  1 , Na Gan  1 , Li Pei  2 , Xue-Lian Zheng  3 , Jun-Bo Hong  1 , Hai-Ying Xiao  1 , Jia-Wei Zhong  1 , Xuan Zhu  4
Affiliations
Observational Study

Natural history of covert hepatic encephalopathy: An observational study of 366 cirrhotic patients

An-Jiang Wang et al. World J Gastroenterol. .

Abstract

Aim: To explore the natural history of covert hepatic encephalopathy (CHE) in absence of medication intervention.

Methods: Consecutive outpatient cirrhotic patients in a Chinese tertiary care hospital were enrolled and evaluated for CHE diagnosis. They were followed up for a mean of 11.2 ± 1.3 mo. Time to the first cirrhosis-related complications requiring hospitalization, including overt HE (OHE), resolution of CHE and death/transplantation, were compared between CHE and no-CHE patients. Predictors for complication(s) and death/transplantation were also analyzed.

Results: A total of 366 patients (age: 47.2 ± 8.6 years, male: 73.0%) were enrolled. CHE was identified in 131 patients (35.8%). CHE patients had higher rates of death and incidence of complications requiring hospitalization, including OHE, compared to unimpaired patients. Moreover, 17.6% of CHE patients developed OHE, 42.0% suffered persistent CHE, and 19.8% of CHE spontaneously resolved. In CHE patients, serum albumin < 30 g/L (HR = 5.22, P = 0.03) was the sole predictor for developing OHE, and blood creatinine > 133 μmol/L (HR = 4.75, P = 0.036) predicted mortality. Child-Pugh B/C (HR = 0.084, P < 0.001) and OHE history (HR = 0.15, P = 0.014) were predictors of spontaneous resolution of CHE.

Conclusion: CHE exacerbates, persists or resolves without medication intervention in clinically stable cirrhosis. Triage of patients based on these predictors will allow for more cost-effect management of CHE.

Keywords: Covert hepatic encephalopathy; Liver cirrhosis; Natural history; Overt hepatic encephalopathy.

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Conflict of interest statement

Conflict-of-interest statement: None of the authors has declared any conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of cirrhotic patients included in the study. CHE: Covert hepatic encephalopathy; OHE: Overt hepatic encephalopathy; TIPS: Transjugular intrahepatic portosystemic stent.
Figure 2
Figure 2
Time from inclusion to development of the first cirrhosis-related complications requiring hospitalization and death for patients with and without covert hepatic encephalopathy. A: Time from inclusion to development of OHE; B: Time from inclusion to development of the first cirrhosis-related complications requiring hospitalization; C: Time from inclusion to death. The Kaplan-Meier curve for estimated cumulative incidence in the Y axis and months from initial entry in the X axis. Log-rank statistics were used to compare groups. CHE: Covert hepatic encephalopathy; OHE: Overt hepatic encephalopathy.
See this image and copyright information in PMC

References

    1. Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, Weissenborn K, Wong P. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014;60:715–735. - PubMed
    1. American Association for the Study of Liver Diseases; European Association for the Study of the Liver. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases. J Hepatol. 2014;61:642–659. - PubMed
    1. Iwasa M, Sugimoto R, Mifuji-Moroka R, Hara N, Yoshikawa K, Tanaka H, Factors contributing to the development of overt encephalopathy in liver cirrhosis patients. Metab Brain Dis. 2016;31:1151–1156. - PubMed
    1. Romero-Gómez M, Boza F, García-Valdecasas MS, García E, Aguilar-Reina J. Subclinical hepatic encephalopathy predicts the development of overt hepatic encephalopathy. Am J Gastroenterol. 2001;96:2718–2723. - PubMed
    1. Riggio O, Amodio P, Farcomeni A, Merli M, Nardelli S, Pasquale C, Pentassuglio I, Gioia S, Onori E, Piazza N, et al. A Model for Predicting Development of Overt Hepatic Encephalopathy in Patients With Cirrhosis. Clin Gastroenterol Hepatol. 2015;13:1346–1352. - PubMed

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