Up to 13% with dementia may instead have ‘treatable’ HE due to undiagnosed cirrhosis
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Key takeaways:
- Elevated FIB-4 index was linked to viral hepatitis, congestive heart failure, HIV, male sex, chronic kidney disease and alcohol use disorder.
- White race and diabetes were inversely associated with FIB-4.
Up to 13% of patients with dementia have lab values that suggest undiagnosed cirrhosis and possible hepatic encephalopathy, an “easily treatable” cause of cognitive impairment, according to a study in The American Journal of Medicine.
“We undertook this [study] because of a growing and aging population of patients with cirrhosis who can have hepatic encephalopathy (HE) that is underdiagnosed,” Jasmohan S. Bajaj, MD, MS, FACG, study author and professor in the division of gastroenterology, hepatology and nutrition at Virginia Commonwealth University School of Medicine, told Healio. “We found a 10% rate of undiagnosed cirrhosis in veterans with dementia but wanted to extend this to nonveterans.”
In a retrospective cohort study, Bajaj and colleagues used the TriNetX database to identify 68,807 nonveteran U.S. patients (mean age, 72.73 years; 44.7% men; 78% white) diagnosed with dementia between 2009 and 2019. Eligible patients had no prior diagnosis of cirrhosis.
Researchers examined the prevalence of an elevated FIB-4 index at two cut-offs points (> 2.67 and > 3.25) indicative of advanced fibrosis and potentially undiagnosed cirrhosis. At baseline, 7.6% of patients had a FIB-4 index greater than 3.25 and 12.8% had an index greater than 2.67.
“Thirteen percent of patients with dementia had potentially undiagnosed cirrhosis in this multicenter analysis of nonveterans,” Bajaj, said. “This could be potentially due to HE that is easily treatable compared to dementia if it were a contributor towards their brain dysfunction.”
According to multivariable analysis, risk factors linked to the highest odds of a FIB-4 greater than 3.25 include infection with hepatitis B or C virus (OR = 2.23; 95% CI, 1.84-2.68), congestive heart failure (OR = 1.73; 95% CI, 1.59-1.87), HIV (OR = 1.72; 95% CI, 1.31-2.23), male sex (OR = 1.42; 95% CI, 1.33-1.51), chronic kidney disease (OR = 1.38; 95% CI, 1.28-1.48) and alcohol use disorder (OR = 1.39; 95% CI, 1.22-1.58). Conversely, white race (OR = 0.76; 95% CI, 0.71-0.82) and diabetes (OR = 0.82; 95% CI, 0.77-0.88) were associated with the lowest odds of an elevated FIB-4.
Researchers reported similar results for a FIB-4 greater than 2.67.
“Undiagnosed cirrhosis can predispose patients to hepatocellular cancer and, if they had undiagnosed HE, this could be treated to potentially improve their brain function,” Bajaj told Healio. “Practitioners taking care of patients with dementia should be aware of a potential overlap with HE, which is treatable.”
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