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

28 Citations (Scopus)

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

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Hepatic Encephalopathy
Fibrosis
Mortality
End Stage Liver Disease
Shock
Systemic Inflammatory Response Syndrome
North America
Leukocyte Count
Tertiary Care Centers
Respiratory Insufficiency
Renal Insufficiency
Ventilation

Keywords

  • ACLF
  • Infection
  • NACSELD
  • SIRS

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Hepatic Encephalopathy Is Associated With Mortality in Patients With Cirrhosis Independent of Other Extrahepatic Organ Failures. / Bajaj, Jasmohan S.; O'Leary, Jacqueline G.; Tandon, Puneeta; Wong, Florence; Garcia-Tsao, Guadalupe; Kamath, Patrick Sequeira; Maliakkal, Benedict; Biggins, Scott W.; Thuluvath, Paul J.; Fallon, Michael B.; Subramanian, Ram M.; Vargas, Hugo E; Lai, Jennifer; Thacker, Leroy R.; Reddy, K. Rajender.

In: Clinical Gastroenterology and Hepatology, 2016.

Research output: Contribution to journalArticle

Bajaj, JS, O'Leary, JG, Tandon, P, Wong, F, Garcia-Tsao, G, Kamath, PS, Maliakkal, B, Biggins, SW, Thuluvath, PJ, Fallon, MB, Subramanian, RM, Vargas, HE, Lai, J, Thacker, LR & Reddy, KR 2016, '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
Bajaj, Jasmohan S. ; O'Leary, Jacqueline G. ; Tandon, Puneeta ; Wong, Florence ; Garcia-Tsao, Guadalupe ; Kamath, Patrick Sequeira ; Maliakkal, Benedict ; Biggins, Scott W. ; Thuluvath, Paul J. ; Fallon, Michael B. ; Subramanian, Ram M. ; Vargas, Hugo E ; Lai, Jennifer ; Thacker, Leroy R. ; Reddy, K. Rajender. / Hepatic Encephalopathy Is Associated With Mortality in Patients With Cirrhosis Independent of Other Extrahepatic Organ Failures. In: Clinical Gastroenterology and Hepatology. 2016.
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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.",
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AU - Bajaj, Jasmohan S.

AU - O'Leary, Jacqueline G.

AU - Tandon, Puneeta

AU - Wong, Florence

AU - Garcia-Tsao, Guadalupe

AU - Kamath, Patrick Sequeira

AU - Maliakkal, Benedict

AU - Biggins, Scott W.

AU - Thuluvath, Paul J.

AU - Fallon, Michael B.

AU - Subramanian, Ram M.

AU - Vargas, Hugo E

AU - Lai, Jennifer

AU - Thacker, Leroy R.

AU - Reddy, K. Rajender

PY - 2016

Y1 - 2016

N2 - 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.

AB - 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.

KW - ACLF

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KW - NACSELD

KW - SIRS

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