S1137 Low Yield of Head Computed Tomography (HCT) in Cirrhotic Patients Presenting With Altered Mentation

Abstract

INTRODUCTION: Hepatic encephalopathy is a known complication of liver cirrhosis that often manifests as a change in mental status. This study aims to investigate the utility in obtaining a head computerized tomography (HCT) in patients presenting with hepatic encephalopathy by correlating presence or absence of focal neurological deficits (FND) to imaging findings. METHODS: Retrospective review of cirrhotic patient admissions with hepatic encephalopathy between 2016-2018 at William Beaumont Hospital in Michigan was performed. Two reviewers independently reviewed automated reports generated for variables of interest using an electronic health record query tool. Low risk indication for HCT was defined as altered mental status in the absence of trauma or FNDs. Descriptive statistics, univariate analyses by t-tests/2 tests and logistic regression were performed to identify clinical features associated with acute abnormalities on HCT using SPSS. RESULTS: 520 unique admissions were reviewed. Mean age was 63.4 ± 12.1 years, M:F ratio was 1.31:1, 187 (36.0%) had alcoholic cirrhosis, and median MELD score was 17 (13-23). Indication for HCT was altered mental status (AMS) in 408 (78.5%) patients and FNDs only reported in 24 (4.6%) patients. 13 (2.5%) patients had acute intracranial pathology (7 hemorrhagic stroke, 2 ischemic stroke, 4 subdural hematoma) on HCT. Presence of FNDs (OR: 6.9, 95% CI: 1.8–27.1), a high risk indication for HCT (OR: 6.2, 95% CI: 2.0–19.3), and antiplatelet use (OR: 5.8, 95% CI: 1.6–21.2) were positive correlates of acute intracranial pathology on HCT. Age, sex, MELD score, hemoglobin, platelet count, race, and cirrhosis etiology did not correlate with HCT abnormalities. Number needed to screen to identify one acute pathology was 14 vs. 82 for high risk indications vs. low risk indications. CONCLUSION: Routine HCTs in cirrhotic patients presenting with hepatic encephalopathy with AMS in the absence of history of trauma, FNDs, or aspirin use are costly and of low diagnostic yield. In addition, in patients with liver cirrhosis, the risks and benefits of aspirin use should be carefully weighed.Table 1.: Cohort demographics and clinical characteristicsTable 2.: Head computed tomography (HCT) findings and indications