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Covert HE increased risk for hospitalization, mortality in cirrhotics

A high prevalence of covert hepatic encephalopathy led to a greater risk for hospitalization, liver transplantation and death, among patients with cirrhosis, according to data from a recent study.

Patients with cirrhosis and without overt hepatic encephalopathy (n=170; OHE), enrolled at Virginia Commonwealth University Hospital between November 2008 and November 2013, were given a standard cognitive battery to explore evidence of covert HE. Researchers, including Jasmohan S. Bajaj, MD, division of gastroenterology, hepatology and nutrition, VCU and McGuire VA Medical Center, conducted follow-up for 13 ± 14.6 months and used Cox regression analysis to compare patients with covert HE to those without it.

Jasmohan S. Bajaj

“A large proportion of patients with cirrhosis who do not have a prior history of hepatic encephalopathy and who may appear ‘stable’ in clinic could actually have severe cognitive problems that are not captured by the MELD score,” Bajaj told Healio.com/Hepatology.

During follow-up, 30% of enrolled patients developed their first OHE episode, 42% were hospitalized and 19% died or underwent liver transplantation, according to the research. Thirty-eight percent of patients with covert HE experienced at least one OHE event vs. 17% among the patients without covert HE (P=.001). The number of overt HE events during follow-up was greater in the covert HE group compared with the group without covert HE (73 vs. 35; P≤.001). Hospitalizations were greater among the covert HE patients compared with patients without covert HE (42 vs. 18; P=.004). Cox regression analysis showed that patients with covert HE had a greater risk for developing OHE (HR=2.1; 95% CI, 1.01-4.5), being hospitalized (HR=2.5; 95% CI, 1.4-4.5) and undergoing transplant or mortality (HR=3.4; 95% CI, 1.2-9.7) during follow-up compared with patients without covert HE.

“We found that these patients have a high risk of developing clinically overt hepatic encephalopathy, getting hospitalized and for dying compared to those who do not have this cognitive issue,” Bajaj told Healio.com/Hepatology.

“Testing for covert hepatic encephalopathy, [which] can be performed using several techniques, can guide us to make decisions regarding the prognosis and also counsel patients about their risks,” Bajaj said. – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.