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
ISSN: 08159319





JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY
Editorial
WILEY, 111 RIVER ST, HOBOKEN 07030-5774, NJ USA, Australia
Tipo de documento: Article
Volumen: 33 Número: 3
Páginas: 718-725
WOS Id: 000425735300026
ID de PubMed: 28768371

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