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. 2023 Nov 6;7(11):e0307.
doi: 10.1097/HC9.0000000000000307. eCollection 2023 Nov 1.

Predicting hepatic encephalopathy in patients with cirrhosis: A UK population-based study and validation of risk scores

Bethan I Jones  1 , Cerys A Jenkins  1 , Daniel Murphy  2 , James Orr  3 , Andrew Yeoman  4 , Ellen R Hubbuck  1 , Ben R Heywood  1 , Craig J Currie  1   5
Affiliations

Predicting hepatic encephalopathy in patients with cirrhosis: A UK population-based study and validation of risk scores

Bethan I Jones et al. Hepatol Commun. .

Abstract

Background: HE is a common neurologic complication in cirrhosis associated with substantial disease and economic burden. HE symptoms are nonspecific and there are limited ways of identifying patients with cirrhosis at high risk of later developing HE. A risk score was previously developed to identify patients at risk of developing HE in a predominately male US cohort. Here, we evaluated the performance of the HE risk scores in a UK cohort study.

Methods: Health care records from Clinical Practice Research Datalink and linked Hospital Episode Statistics were used to select patients with cirrhosis who were diagnosed with HE, confirmed by a diagnosis code for HE or a rifaximin-α prescription. The index date was the date of incident cirrhosis. The study period was from January 2003 to June 2019.

Results: A total of 40,809 patients with cirrhosis were selected in the UK cohort, of whom 59% were male. A total of 1561 patients were diagnosed with HE. Applying the UK cohort to the baseline sensitivity risk cutoff (≥-11) from the US cohort provided a sensitivity of 92% and a negative predictive value of 99%. Within a longitudinal model, applying a sensitivity cutoff of ≥-3 to this cohort gave a sensitivity of 89% and a negative predictive value of 99%.

Conclusions: Using data from the UK, the previously developed HE risk scores were found to be reliable for selecting those most likely to progress to HE in patients with liver cirrhosis. Despite the HE risk scores originally being estimated using the data from a predominately male US cohort, the scores were validated and found to be generalizable to female patients.

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Conflict of interest statement

Cerys A. Jenkins is employed, owns stock, and holds intellectual property rights with the CanSense Group. Daniel Murphy is employed by Norgine Ltd. Bethan I. Jones, Ellen R. Hubbuck, and Cerys A. Jenkins are employed by, and Craig J. Currie is a director of Pharmatelligence Limited (trading as Human Data Sciences), a research consultancy receiving funding from Norgine Pharmaceuticals Limited for the submitted work. The remaining authors have no conflicts to report.

Figures

FIGURE 1
FIGURE 1
Attrition flow diagram combining CPRD Aurum and CPRD GOLD data sets. Abbreviation: CPRD, Clinical Practice Research Datalink.
FIGURE 2
FIGURE 2
(A) Baseline model change in sensitivity and specificity as the cutoff is increased. (B) Longitudinal model change in sensitivity and specificity as cutoff is increased.
See this image and copyright information in PMC

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