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Minimal hepatic encephalopathy identifies patients at risk of faster cirrhosis progression
Author(s) -
Ampuero Javier,
Montoliú Carmina,
SimónTalero Macarena,
Aguilera Virginia,
Millán Raquel,
Márquez Celina,
Jover Rodrigo,
Rico María Carmen,
Sendra Carmen,
Serra Miguel Ángel,
RomeroGómez Manuel
Publication year - 2018
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13917
Subject(s) - medicine , hepatic encephalopathy , cirrhosis , gastroenterology , cumulative incidence , stage (stratigraphy) , model for end stage liver disease , liver disease , surrogate endpoint , hepatocellular carcinoma , confidence interval , incidence (geometry) , varices , encephalopathy , liver transplantation , transplantation , paleontology , physics , optics , biology
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.