Risk of recurrent hepatic encephalopathy in patients with liver cirrhosis: a German registry study

TY - JOUR

T1 - Risk of recurrent hepatic encephalopathy in patients with liver cirrhosis: a German registry study

AU - Gabriel, Maria M

AU - Kircheis, Gerald

AU - Hardtke, Svenja

AU - Markwardt, Daniel

AU - Buggisch, Peter

AU - Mix, Heiko

AU - Grüngreiff, Kurt

AU - Welzel, Tanja M

AU - Kälsch, Julia

AU - Hartmann, Heinz

AU - Gerbes, Alexander L

AU - Karpowitz, Maria V

AU - Seeliger, Benjamin

AU - Wedemeyer, Heiner

AU - Weissenborn, Karin

AU - HepNet HE-Register Study Group

PY - 2021/9/1

Y1 - 2021/9/1

N2 - BACKGROUND AND AIMS: Patients with hepatic encephalopathy (HE) show low quality of life, recurrent hospitalizations and an increased mortality. We aimed to assess the natural course of patients after a recent episode of overt HE and to identify risk factors for HE recurrence in Germany.METHODS: Fifteen sites took part in a prospective, observational study including patients with liver cirrhosis who had been hospitalized for HE within 3 months before recruitment. Clinical data, psychometric hepatic encephalopathy score (PHES) and critical flicker frequency were assessed quarterly for 1 year. Primary endpoint was HE recurrence requiring hospitalization, all-cause-mortality was treated as a competing risk factor.RESULTS: From January 2014 to March 2016, a total of 115 patients were recruited. Overall 14 premature deaths were documented. For 78 subjects follow-up data were available in accordance with the protocol. After a median of 118 days, more than half of the per-protocol cohort was readmitted to hospital due to HE (N = 34) or died (N = 11). The risk for hospitalization was significantly increased in patients who had been recruited by liver transplant centers (P = 0.003), had had frequent HE relapses prior to recruitment (P = <0.0001) or an abnormal PHES result of <-4 (P = 0.044). Abnormal PHES results barely missed level of significance as an independent risk factor for re-hospitalization in a multivariable competing risk model (P = 0.093).CONCLUSION: Patients with a history of HE are at high risk for the development of recurrent overt HE demanding hospitalization. The PHES test may aid in detection, monitoring and risk stratification of recurrent HE.

AB - BACKGROUND AND AIMS: Patients with hepatic encephalopathy (HE) show low quality of life, recurrent hospitalizations and an increased mortality. We aimed to assess the natural course of patients after a recent episode of overt HE and to identify risk factors for HE recurrence in Germany.METHODS: Fifteen sites took part in a prospective, observational study including patients with liver cirrhosis who had been hospitalized for HE within 3 months before recruitment. Clinical data, psychometric hepatic encephalopathy score (PHES) and critical flicker frequency were assessed quarterly for 1 year. Primary endpoint was HE recurrence requiring hospitalization, all-cause-mortality was treated as a competing risk factor.RESULTS: From January 2014 to March 2016, a total of 115 patients were recruited. Overall 14 premature deaths were documented. For 78 subjects follow-up data were available in accordance with the protocol. After a median of 118 days, more than half of the per-protocol cohort was readmitted to hospital due to HE (N = 34) or died (N = 11). The risk for hospitalization was significantly increased in patients who had been recruited by liver transplant centers (P = 0.003), had had frequent HE relapses prior to recruitment (P = <0.0001) or an abnormal PHES result of <-4 (P = 0.044). Abnormal PHES results barely missed level of significance as an independent risk factor for re-hospitalization in a multivariable competing risk model (P = 0.093).CONCLUSION: Patients with a history of HE are at high risk for the development of recurrent overt HE demanding hospitalization. The PHES test may aid in detection, monitoring and risk stratification of recurrent HE.

U2 - 10.1097/MEG.0000000000001822

DO - 10.1097/MEG.0000000000001822

M3 - SCORING: Journal article

C2 - 32658009

VL - 33

SP - 1185

EP - 1193

JO - EUR J GASTROEN HEPAT

JF - EUR J GASTROEN HEPAT

SN - 0954-691X

IS - 9

ER -