Hepatic encephalopathy as a predictor of survival in patients with end-stage liver disease

Charmaine A. Stewart, Michael Malinchoc, W. Ray Kim, Patrick Sequeira Kamath

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157 Citations (Scopus)

Abstract

Hepatic encephalopathy (HE) is an important component of hepatic decompensation, which reduces survival in patients with cirrhosis. The Model for End-Stage Liver Disease (MELD) score has been used to predict survival of patients with cirrhosis. The aims of this study were to determine whether HE is a predictor of survival of patients with cirrhosis and to examine the degree to which HE may add to the survival prediction of MELD. Patients with end-stage liver disease whose data were included in 2 databases were included in the analysis: 223 patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) insertion, and 271 patients hospitalized with hepatic decompensation. In univariate analysis, HE grade 3 or higher was associated with a 3.7-fold (95% confidence interval, 1.9-7.3, P < 0.01) increase in the risk of death in the TIPS patients and HE grade 2 or higher was associated 3.9-fold increase (95% confidence interval [95% CI], 2.6-5.7, P < 0.01) in hospitalized patients. As expected, MELD and Child-Turcotte-Pugh scores (with and without HE included) were also markedly associated with survival. When HE (grade 2 or higher) and MELD were considered together, HE remained strongly statistically significant in the hospitalized patients (hazard ratio = 2.6, 95% Cl, 1.7-3.8, P < 0.01). The effect became smaller in the TIPS patients (hazard ratio = 1.1; 95% Cl, 0.7-1.6, P = 0.76). In conclusion, this retrospective study demonstrates that HE is an important event in the natural history of cirrhosis that affects subsequent survival of patients. HE may provide additional prognostic information independent of MELD, which warrants prospective validation.

Original languageEnglish (US)
Pages (from-to)1366-1371
Number of pages6
JournalLiver Transplantation
Volume13
Issue number10
DOIs
StatePublished - Oct 2007

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End Stage Liver Disease
Hepatic Encephalopathy
Survival
Transjugular Intrahepatic Portasystemic Shunt
Fibrosis
Confidence Intervals
Liver
Retrospective Studies
Databases

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Hepatic encephalopathy as a predictor of survival in patients with end-stage liver disease. / Stewart, Charmaine A.; Malinchoc, Michael; Kim, W. Ray; Kamath, Patrick Sequeira.

In: Liver Transplantation, Vol. 13, No. 10, 10.2007, p. 1366-1371.

Research output: Contribution to journalArticle

Stewart, Charmaine A. ; Malinchoc, Michael ; Kim, W. Ray ; Kamath, Patrick Sequeira. / Hepatic encephalopathy as a predictor of survival in patients with end-stage liver disease. In: Liver Transplantation. 2007 ; Vol. 13, No. 10. pp. 1366-1371.
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abstract = "Hepatic encephalopathy (HE) is an important component of hepatic decompensation, which reduces survival in patients with cirrhosis. The Model for End-Stage Liver Disease (MELD) score has been used to predict survival of patients with cirrhosis. The aims of this study were to determine whether HE is a predictor of survival of patients with cirrhosis and to examine the degree to which HE may add to the survival prediction of MELD. Patients with end-stage liver disease whose data were included in 2 databases were included in the analysis: 223 patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) insertion, and 271 patients hospitalized with hepatic decompensation. In univariate analysis, HE grade 3 or higher was associated with a 3.7-fold (95{\%} confidence interval, 1.9-7.3, P < 0.01) increase in the risk of death in the TIPS patients and HE grade 2 or higher was associated 3.9-fold increase (95{\%} confidence interval [95{\%} CI], 2.6-5.7, P < 0.01) in hospitalized patients. As expected, MELD and Child-Turcotte-Pugh scores (with and without HE included) were also markedly associated with survival. When HE (grade 2 or higher) and MELD were considered together, HE remained strongly statistically significant in the hospitalized patients (hazard ratio = 2.6, 95{\%} Cl, 1.7-3.8, P < 0.01). The effect became smaller in the TIPS patients (hazard ratio = 1.1; 95{\%} Cl, 0.7-1.6, P = 0.76). In conclusion, this retrospective study demonstrates that HE is an important event in the natural history of cirrhosis that affects subsequent survival of patients. HE may provide additional prognostic information independent of MELD, which warrants prospective validation.",
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