Minimal hepatic encephalopathy identifies patients at risk of faster cirrhosis progression
Por:
Ampuero, J, Montoliu, C, Simon-Talero, M, Aguilera, V, Millan, R, Marquez, C, Jover R, Carmen Rico, M, Sendra, C, Angel Serra, M and Romero-Gomez, M
Publicada:
1 mar 2018
Resumen:
Background and AimMinimal 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.
MethodsProspective multicenter study including 320 cirrhotic patients,
followed for up to 5years, 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.
ResultsMinimal 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 5.6cases per 100person-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.
ConclusionMinimal 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.
Filiaciones:
Ampuero, J:
Hosp Univ Virgen del Rocio, Digest Dis Dept, Ave Manuel Siurot S-N, Seville 41013, Spain
Hosp Univ Virgen del Rocio, CIBERehd, Ave Manuel Siurot S-N, Seville 41013, Spain
Valme Univ Hosp, Inst Biomed Seville, Seville, Spain
Montoliu, C:
Hosp Clin Univ, Inst Invest Sanitaria INCLIVA, Valencia, Spain
Simon-Talero, M:
Hosp Univ Vall dHebron, Dept Internal Med, Liver Unit, Barcelona, Spain
Aguilera, V:
Hosp Univ Virgen del Rocio, Digest Dis Dept, Ave Manuel Siurot S-N, Seville 41013, Spain
Hosp Univ Virgen del Rocio, CIBERehd, Ave Manuel Siurot S-N, Seville 41013, Spain
Millan, R:
Hosp Univ Virgen del Rocio, Digest Dis Dept, Ave Manuel Siurot S-N, Seville 41013, Spain
Hosp Univ Virgen del Rocio, CIBERehd, Ave Manuel Siurot S-N, Seville 41013, Spain
Valme Univ Hosp, Inst Biomed Seville, Seville, Spain
Jover R:
Hosp Gen Univ, Dept Gastroenterol, Alicante, Spain
Carmen Rico, M:
Hosp Univ Virgen del Rocio, Digest Dis Dept, Ave Manuel Siurot S-N, Seville 41013, Spain
Hosp Univ Virgen del Rocio, CIBERehd, Ave Manuel Siurot S-N, Seville 41013, Spain
Valme Univ Hosp, Inst Biomed Seville, Seville, Spain
Sendra, C:
Hosp Univ Virgen del Rocio, Digest Dis Dept, Ave Manuel Siurot S-N, Seville 41013, Spain
Hosp Univ Virgen del Rocio, CIBERehd, Ave Manuel Siurot S-N, Seville 41013, Spain
Valme Univ Hosp, Unit Clin Management Digest Dis, Valencia, Spain
Angel Serra, M:
Hosp Clin Univ, Hepatol Unit, Valencia, Spain
Romero-Gomez, M:
Hosp Univ Virgen del Rocio, Digest Dis Dept, Ave Manuel Siurot S-N, Seville 41013, Spain
Hosp Univ Virgen del Rocio, CIBERehd, Ave Manuel Siurot S-N, Seville 41013, Spain
Valme Univ Hosp, Inst Biomed Seville, Seville, Spain
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