OBJECTIVES: Despite the high prevalence of covert hepatic encephalopathy (CHE) in cirrhotics without previous overt HE (OHE), its independent impact on predicting clinically relevant outcomes is unclear. The aim of this study was to define the impact of CHE on time to OHE, hospitalization, and death/transplant in prospectively followed up patients without previous OHE. METHODS: Outpatient cirrhotics without OHE were enrolled and were administered a standard paper-pencil cognitive battery for CHE diagnosis. They were systematically followed up and time to first OHE development, hospitalization (liver-related/unrelated), and transplant/death were compared between CHE and no-CHE patients at baseline using Cox regression. RESULTS: A total of 170 cirrhotic patients (55 years, 58% men, 14 years of education, Model for End-Stage Liver Disease (MELD 9), 53% hepatitis C virus (HCV), 20% nonalcoholic etiology) were included, of whom 56% had CHE. The entire population was followed up for 13.0 ± 14.6 months, during which time 30% developed their first OHE episode, 42% were hospitalized, and 19% had a composite death/transplant outcome. Age, gender, etiology, the MELD score, and CHE status were included in Cox regression models for time to first OHE episode, hospitalization, death, and composite death/transplant outcomes. On Cox regression, despite controlling for MELD, those with CHE had a higher risk of developing OHE (hazard ratio: 2.1, 95% confidence interval 1.01-4.5), hospitalization (hazard ratio: 2.5, 95% confidence interval 1.4-4.5), and death/transplant (hazard ratio: 3.4, 95% confidence interval 1.2-9.7) in the follow-up period. CONCLUSIONS: Covert HE is associated with worsened survival and increased risk of hospitalization and OHE development, despite controlling for the MELD score. Strategies to detect and treat CHE may improve these risks.
OBJECTIVES: Despite the high prevalence of covert hepatic encephalopathy (CHE) in cirrhotics without previous overt HE (OHE), its independent impact on predicting clinically relevant outcomes is unclear. The aim of this study was to define the impact of CHE on time to OHE, hospitalization, and death/transplant in prospectively followed up patients without previous OHE. METHODS:Outpatient cirrhotics without OHE were enrolled and were administered a standard paper-pencil cognitive battery for CHE diagnosis. They were systematically followed up and time to first OHE development, hospitalization (liver-related/unrelated), and transplant/death were compared between CHE and no-CHEpatients at baseline using Cox regression. RESULTS: A total of 170 cirrhotic patients (55 years, 58% men, 14 years of education, Model for End-Stage Liver Disease (MELD 9), 53% hepatitis C virus (HCV), 20% nonalcoholic etiology) were included, of whom 56% had CHE. The entire population was followed up for 13.0 ± 14.6 months, during which time 30% developed their first OHE episode, 42% were hospitalized, and 19% had a composite death/transplant outcome. Age, gender, etiology, the MELD score, and CHE status were included in Cox regression models for time to first OHE episode, hospitalization, death, and composite death/transplant outcomes. On Cox regression, despite controlling for MELD, those with CHE had a higher risk of developing OHE (hazard ratio: 2.1, 95% confidence interval 1.01-4.5), hospitalization (hazard ratio: 2.5, 95% confidence interval 1.4-4.5), and death/transplant (hazard ratio: 3.4, 95% confidence interval 1.2-9.7) in the follow-up period. CONCLUSIONS: Covert HE is associated with worsened survival and increased risk of hospitalization and OHE development, despite controlling for the MELD score. Strategies to detect and treat CHE may improve these risks.
Authors: Jasmohan S Bajaj; Jason M Ridlon; Phillip B Hylemon; Leroy R Thacker; Douglas M Heuman; Sean Smith; Masoumeh Sikaroodi; Patrick M Gillevet Journal: Am J Physiol Gastrointest Liver Physiol Date: 2011-09-22 Impact factor: 4.052
Authors: Jasmohan S Bajaj; James B Wade; Douglas P Gibson; Douglas M Heuman; Leroy R Thacker; Richard K Sterling; R Todd Stravitz; Velimir Luketic; Michael Fuchs; Melanie B White; Debulon E Bell; HoChong Gilles; Katherine Morton; Nicole Noble; Puneet Puri; Arun J Sanyal Journal: Am J Gastroenterol Date: 2011-05-10 Impact factor: 10.864
Authors: Jasmohan S Bajaj; Leroy R Thacker; Douglas M Heuman; Richard K Sterling; R Todd Stravitz; Arun J Sanyal; Velimir Luketic; Michael Fuchs; Ho Chong S Gilles; James B Wade Journal: Liver Transpl Date: 2012-10 Impact factor: 5.799
Authors: Sara Montagnese; Michele De Rui; Sami Schiff; Elena Ceranto; Pietro Valenti; Paolo Angeli; Umberto Cillo; Giacomo Zanus; Angelo Gatta; Piero Amodio; Carlo Merkel Journal: Liver Int Date: 2014-03-12 Impact factor: 5.828
Authors: M M Lauridsen; L Poulsen; C K Rasmussen; M Høgild; M K Nielsen; O B Schaffalitzky de Muckadell; H Vilstrup Journal: Metab Brain Dis Date: 2015-10-05 Impact factor: 3.584
Authors: Jasmohan S Bajaj; Andrew Fagan; Melanie B White; James B Wade; Phillip B Hylemon; Douglas M Heuman; Michael Fuchs; Binu V John; Chathur Acharya; Masoumeh Sikaroodi; Patrick M Gillevet Journal: Am J Gastroenterol Date: 2019-07 Impact factor: 10.864
Authors: Kim M Olthoff; Abigail R Smith; Michael Abecassis; Talia Baker; Jean C Emond; Carl L Berg; Charlotte A Beil; James R Burton; Robert A Fisher; Chris E Freise; Brenda W Gillespie; David R Grant; Abhinav Humar; Igal Kam; Robert M Merion; Elizabeth A Pomfret; Benjamin Samstein; Abraham Shaked Journal: Ann Surg Date: 2015-09 Impact factor: 12.969