Javier Ampuero1,2, Carmina Montoliú3, Macarena Simón-Talero4, Virginia Aguilera1, Raquel Millán1,2, Celina Márquez5, Rodrigo Jover6, María Carmen Rico1,2, Carmen Sendra1, Miguel Ángel Serra7, Manuel Romero-Gómez1,2. 1. Digestive Disease Department and CIBERehd, Hospital Universitario Virgen del Rocío, Sevilla, Spain. 2. Institute of Biomedicine of Seville, Sevilla, Spain. 3. Instituto de Investigación Sanitaria - INCLIVA, Valencia, Spain. 4. Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebrón, Barcelona, Spain. 5. Unit for the Clinical Management of Digestive Diseases, Valme University Hospital, Sevilla, Spain. 6. Gastroenterology Department, Hospital General Universitario, Alicante, Spain. 7. Hepatology Unit, Hospital Clínico Universitario, Valencia, Spain.
Abstract
BACKGROUND AND AIM: Minimal hepatic encephalopathy (MHE) predicts poor prognosis and could reflect an advanced liver disease. We aimed to assess whether MHE could be a surrogate marker of a further liver disease. METHODS: Prospective multicenter study including 320 cirrhotic patients, followed for up to 5 years, which were classified at baseline in compensated cirrhosis without (stage 1) and with varices (stage 2), one decompensating event (stage 3), and any second decompensating event (stage 4). Cirrhosis progression was defined by a transition towards a different stage (competing events: liver transplant due to hepatocellular carcinoma and non-liver-related death). MHE was detected by critical flicker frequency and psychometric tests. RESULTS: Minimal hepatic encephalopathy was diagnosed in 18.2% (57/314) of patients. Cirrhosis progression occurred in 38.1% (122/320) of patients, while liver transplant was required in 10.9% (35/320), and 19.1% (61/320) died. In competing risk regression, MHE was associated with disease progression: model 1 {subhazard ratio [sHR] 2.34 [95%confidence interval (CI) 1.58-3.46]; P = 0.0001}; model 2 [sHR 2.18 (95%CI 1.43-3.33); P = 0.0001]; model 3 [sHR 2.48 (95%CI 1.63-3.76); P = 0.0001]. The annual incidence rate of progression was higher in MHE patients: stage 1 (19.4 vs 5.6 cases per 100 person-years); stage 2 (26.8 vs 15.6); stage 3 (45.7 vs 16.5); and stage 4 (40.7 vs 12.8). MHE showed a higher cumulative incidence of disease progression from the first year in decompensated and the third year in compensated cirrhosis. CONCLUSION: Minimal hepatic encephalopathy was associated with cirrhosis progression and showed a higher cumulative and annual incidence rate of disease progression. MHE could be a surrogate marker of disease progression, irrespective of cirrhosis status, identifying patients at risk of suffering a more aggressive cirrhosis form.
BACKGROUND AND AIM: Minimal hepatic encephalopathy (MHE) predicts poor prognosis and could reflect an advanced liver disease. We aimed to assess whether MHE could be a surrogate marker of a further liver disease. METHODS: Prospective multicenter study including 320 cirrhotic patients, followed for up to 5 years, which were classified at baseline in compensated cirrhosis without (stage 1) and with varices (stage 2), one decompensating event (stage 3), and any second decompensating event (stage 4). Cirrhosis progression was defined by a transition towards a different stage (competing events: liver transplant due to hepatocellular carcinoma and non-liver-related death). MHE was detected by critical flicker frequency and psychometric tests. RESULTS: Minimal hepatic encephalopathy was diagnosed in 18.2% (57/314) of patients. Cirrhosis progression occurred in 38.1% (122/320) of patients, while liver transplant was required in 10.9% (35/320), and 19.1% (61/320) died. In competing risk regression, MHE was associated with disease progression: model 1 {subhazard ratio [sHR] 2.34 [95%confidence interval (CI) 1.58-3.46]; P = 0.0001}; model 2 [sHR 2.18 (95%CI 1.43-3.33); P = 0.0001]; model 3 [sHR 2.48 (95%CI 1.63-3.76); P = 0.0001]. The annual incidence rate of progression was higher in MHE patients: stage 1 (19.4 vs 5.6 cases per 100 person-years); stage 2 (26.8 vs 15.6); stage 3 (45.7 vs 16.5); and stage 4 (40.7 vs 12.8). MHE showed a higher cumulative incidence of disease progression from the first year in decompensated and the third year in compensated cirrhosis. CONCLUSION: Minimal hepatic encephalopathy was associated with cirrhosis progression and showed a higher cumulative and annual incidence rate of disease progression. MHE could be a surrogate marker of disease progression, irrespective of cirrhosis status, identifying patients at risk of suffering a more aggressive cirrhosis form.
Authors: Christian Labenz; Gerrit Toenges; Jörn M Schattenberg; Michael Nagel; Yvonne Huber; Jens U Marquardt; Joachim Labenz; Peter R Galle; Marcus-Alexander Wörns Journal: Clin Transl Gastroenterol Date: 2020-06 Impact factor: 4.396