The summaries are free for public
use. The Chronic Liver Disease
Foundation will continue to add and
archive summaries of articles deemed
relevant to CLDF by the Board of
Trustees and its Advisors.
Abstract Details
Hepatic encephalopathy increases the risk for mortality and hospital readmission in decompensated cirrhotic patients: a prospective multicenter study
Front Med (Lausanne). 2023 May 25;10:1184860. doi: 10.3389/fmed.2023.1184860.eCollection 2023.
1Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
2Department of Gastroenterology, "Santa Maria Goretti" Hospital, "Sapienza" Polo Pontino, Latina, Italy.
3Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy.
4Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy.
5Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy.
6Department of Medical and Surgical Sciences, Center for Biomedical Applied Research, Alma Mater Studiorum University of Bologna, Bologna, Italy.
7Department of Medicine, University of Padova, Padua, Italy.
8Medicina Interna e Gastroenterologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.
9Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome, Italy.
10Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy.
11Division of Medicine and Hepatology, University Hospital of Messina, Messina, Italy.
12Department of Gastroenterology and Hepatology, Università Politecnica delle Marche, Ancona, Italy.
13Gastroenterology/Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy.
14Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy.
15Internal Medicine and Hepatology Unit, Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Salerno, Italy.
16Gastroenterology Unit, Department of Medical Specialities, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy.
17Unit of Gastroenterology, Borgo Trento University Hospital, Verona, Italy.
18Gastroentyerology, University of Milan Bicocca, Milan, Italy.
19Gastroenterology, Hepatology and Transplantation Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy.
20Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy.
21Internal Medicine Unit, Azienda Ospedaliera Universitaria (AOU) Maggiore della Carità Hospital, Novara, Italy.
22Section of Gastroenterology, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy.
23Gastroenterology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Department of Surgical and Medical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
24Clinic of Internal Medicine-Liver Unit, Department of Medical Area (DAME), University of Udine, Udine, Italy.
25Italian Liver Foundation, Area Science Park, Trieste, Italy.
26Liver Unit, Azienda di Rilievo Nazionale ed Alta Specializzazione (ARNAS) Garibaldi-Nesima, Catania, Italy.
27Gastroenterology and Hepatology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.
28Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy.
29Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
30General Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
31Department of Internal and Emergency Medicine, University Hospital of Modena, Modena, Italy.
#Contributed equally.
Abstract
Introduction: Hepatic encephalopathy (HE) affects the survival and quality of life of patients with cirrhosis. However, longitudinal data on the clinical course after hospitalization for HE are lacking. The aim was to estimate mortality and risk for hospital readmission of cirrhotic patients hospitalized for HE.
Methods: We prospectively enrolled 112 consecutive cirrhotic patients hospitalized for HE (HE group) at 25 Italian referral centers. A cohort of 256 patients hospitalized for decompensated cirrhosis without HE served as controls (no HE group). After hospitalization for HE, patients were followed-up for 12 months until death or liver transplant (LT).
Results: During follow-up, 34 patients (30.4%) died and 15 patients (13.4%) underwent LT in the HE group, while 60 patients (23.4%) died and 50 patients (19.5%) underwent LT in the no HE group. In the whole cohort, age (HR 1.03, 95% CI 1.01-1.06), HE (HR 1.67, 95% CI 1.08-2.56), ascites (HR 2.56, 95% CI 1.55-4.23), and sodium levels (HR 0.94, 95% CI 0.90-0.99) were significant risk factors for mortality. In the HE group, ascites (HR 5.07, 95% CI 1.39-18.49) and BMI (HR 0.86, 95% CI 0.75-0.98) were risk factors for mortality, and HE recurrence was the first cause of hospital readmission.
Conclusion: In patients hospitalized for decompensated cirrhosis, HE is an independent risk factor for mortality and the most common cause of hospital readmission compared with other decompensation events. Patients hospitalized for HE should be evaluated as candidates for LT.
Stay Informed!
