Hepatic Encephalopathy Is Associated With Mortality in Patients With Cirrhosis Independent of Other Extrahepatic Organ Failures

Jasmohan S. Bajaj, Jacqueline G. O'Leary, Puneeta Tandon, Florence Wong, Guadalupe Garcia-Tsao, Patrick Sequeira Kamath, Benedict Maliakkal, Scott W. Biggins, Paul J. Thuluvath, Michael B. Fallon, Ram M. Subramanian, Hugo E Vargas, Jennifer Lai, Leroy R. Thacker, K. Rajender Reddy

Research output: Contribution to journalArticle

38 Scopus citations

Abstract

Background & Aims: Although survival times have increased for patients with cirrhosis, hepatic encephalopathy (HE) remains a major complication and its relative contribution toward mortality in North America is unclear. We investigated whether HE is associated with mortality independent of extrahepatic organ failures (EHOFs). Methods: We collected data from the North American Consortium for Study of End-stage Liver Disease database of hospitalized patients with cirrhosis at tertiary-care centers. EHOFs were defined as need for ventilation (respiratory failure), dialysis (renal failure), or shock (circulatory failure). We analyzed in-hospital and 30-day mortality for patients with varying HE grades and EHOF using adjusted models. Results: We analyzed data from 1560 patients, 516 with HE (371 grade 1-2 and 145 grade 3-4). Patients with maximum HE grade 3-4 HE during hospitalization had a higher median model for end-stage liver disease (MELD) score (22) than patients with HE grade 1-2 (MELD score, 19) or no HE (MELD score, 18) (P < .0001). Thirty-day mortality for patients with HE grade 3-4 was significantly higher (38%) than for patients with HE grade 1-2 (8%) or no HE (7%). A total of 107 patients had 2 or more EHOFs, with or without HE; 151 had 1 EHOF and 1302 had no organ failure. Unadjusted mortality was highest for patients with HE of grade 3-4 with 2 EHOFs (n = 44). On regression analysis, HE severity was significantly associated with in-hospital and 30-day mortality, independent of any EHOF, white blood cell count, systemic inflammatory response syndrome, or MELD score (odds ratio, 3.3; . P < .0001). Conclusions: In an analysis of more than 1500 patients hospitalized for cirrhosis, HE of grade 3 or 4 was associated with higher in-hospital and 30-day mortality, independently of failure of other organs.

Original languageEnglish (US)
JournalClinical Gastroenterology and Hepatology
DOIs
StateAccepted/In press - 2016

Keywords

  • ACLF
  • Infection
  • NACSELD
  • SIRS

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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    Bajaj, J. S., O'Leary, J. G., Tandon, P., Wong, F., Garcia-Tsao, G., Kamath, P. S., Maliakkal, B., Biggins, S. W., Thuluvath, P. J., Fallon, M. B., Subramanian, R. M., Vargas, H. E., Lai, J., Thacker, L. R., & Reddy, K. R. (Accepted/In press). Hepatic Encephalopathy Is Associated With Mortality in Patients With Cirrhosis Independent of Other Extrahepatic Organ Failures. Clinical Gastroenterology and Hepatology. https://doi.org/10.1016/j.cgh.2016.09.157