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
Risk of recurrent hepatic encephalopathy in patients with liver cirrhosis: a German registry study
Maria M Gabriel1, Gerald Kircheis23, Svenja Hardtke4, Daniel Markwardt5, Peter Buggisch6, Heiko Mix7, Kurt Grüngreiff8, Tanja M Welzel9, Julia Kälsch10, Heinz Hartmann11, Alexander L Gerbes5, Maria V Karpowitz12, Benjamin Seeliger13, Heiner Wedemeyer710, Karin Weissenborn1, HepNet HE-Register Study Group
Author information
1Department of Neurology, Hannover Medical School, Hannover.
2Department of Gastroenterology, Hepatology and Infectiology, Heinrich Heine University Hospital Düsseldorf, Düsseldorf.
3Clinic of Brandenburg, Medical University Brandenburg Theodor Fontane, Brandenburg.
5Department of Medicine II, University Hospital, LMU Munich, Munich.
6ifi-Institute for Interdisciplinary Medicine, Hamburg.
7Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover.
8Practice of Gastroenterology and Clinic of Gastroenterology, City Hospital, Magdeburg.
9Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt.
10Department of Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, Duisburg.
11Practice of Gastroenterology, Herne.
12Institute for Biostatistics, Hannover Medical School.
13Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
Abstract
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.