Abstract
Importance: Hepatic encephalopathy is a severe complication, and its contribution to clinical adverse outcomes in patients with acute-on-chronic liver diseases from the East is unclear.Objective: We aimed to investigate the impact of hepatic encephalopathy on clinical characteristics and adverse outcomes in prospective and multicenter cohorts of patients with acute-on-chronic liver diseases.Design: We conducted a cohort study of two multicenter prospective cohorts.Setting: China.Participants: Acute-on-chronic liver disease patients with various etiologies.Exposure: The diagnosis and severity of hepatic encephalopathy were assessed using the West Haven scale.Main Outcome Measure: The correlation between clinical adverse outcomes and varying hepatic encephalopathy grades was analyzed in the target patients.Results: A total of 3,949 patients were included, and 340 of them had hepatic encephalopathy. The incidence of hepatic encephalopathy was higher in patients with alcohol consumption (9.90%) than in those with hepatitis B virus infection (6.17%). The incidence of 28- and 90-day adverse outcomes increased progressively from hepatic encephalopathy grades 1–4. Logistic regression analysis revealed that hepatic encephalopathy grades 3 and 4 were independent risk factors for the 28- and 90-day adverse outcome in the fully adjusted model IV. Stratified analyses showed similar results in the different subgroups. Compared to grades 1–2 and patients without hepatic encephalopathy, those with grade 3 hepatic encephalopathy had a significant increase in clinical adverse outcomes, independent of other organ failures.Conclusions and Relevance: Hepatic encephalopathy grades 3–4 were independent risk factors for 28- and 90-day adverse outcomes. Hepatic encephalopathy grade 3 could be used as an indicator of brain failure in patients with acute-on-chronic liver disease.
Highlights
Chronic liver disease (CLD) is currently an increasing global problem and burden [1,2,3]
Patients were recruited from two prospective multicenter cohorts with acute events of CLD, named CATCH-LIFE (NCT02457637 and NCT03641872), established by the Chinese Chronic Liver Failure Consortium composed of 15 tertiary hospitals in hepatitis B virus (HBV) endemic areas from January 2015 to December 2017 and July 2018 to January 2019, respectively [11, 12]
People with Hepatic encephalopathy (HE) grades 1–4 were older than those without HE (p < 0.001), and male patients were more common than female patients in HE grades 1–4
Summary
Chronic liver disease (CLD) is currently an increasing global problem and burden [1,2,3]. Patients with CLD and acute events are considered to have acute-on-chronic liver diseases (AoCLD) [5]. Hepatic encephalopathy (HE) remains one of the most complex and worrisome complications due to severe hepatocellular dysfunction, the presence of large portal-systemic shunts, or both. It usually presents with a wide spectrum of neurological/psychiatric abnormalities, ranging from subclinical alterations, sleep disturbances, personality changes, abnormal behaviors, and coma [6, 7]. HE leads to considerable mortality and exerts a multidimensional burden on patients, their caregivers, and the national healthcare system [9, 10]
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