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Model may predict overt HE in patients with cirrhosis

Researchers in Italy developed and validated a new model that identified patients with cirrhosis at risk for developing overt hepatic encephalopathy, according to published findings.

“In this prospective observational study, a number of clinical and laboratory variables were recorded and related to the development of overt [hepatic encephalopathy] during the follow-up period,” the researchers wrote. “The prognostic model derived from the observation group enrolled in Rome was tested in an independent validation group of patients observed and followed up with in Padua.”

For the study, data of 216 patients with cirrhosis without overt hepatic encephalopathy (HE) enrolled at the Gastroenterology Unit in Rome between October 2009 and December 2012 were collected and evaluated. Of these patients, 96 presented with minimal HE and 22% had at least one episode of overt HE prior to the study, according to the research.

“We analyzed end-stage liver disease scores, shunt placement, previous overt or minimal HE, psychometric hepatic encephalopathy score, and levels of albumin, bilirubin, creatinine, and sodium to develop a prediction model,” the researchers wrote.

The average follow-up period of the patients was 14.7 ± 11.6 months and afterwards, 112 patients with cirrhosis seen at the University of Padua were used for the validation model and followed up with for an average of 12 ± 9.5 months.

Over the course of follow-up, 32% of patients developed at least one episode of overt HE (n = 68). Multivariate analysis showed that developing overt HE was associated with previous HE, minimal HE based on the psychometric hepatic encephalopathy score (PHES) and a level of albumin less than 3.5 g/dL (area under the curve (AUC) = 0.74). In a second multivariate analysis, when minimal HE was excluded, albumin level and previous HE were identified as independent variables associated with patients who would develop overt HE (AUC = 0.71). The researchers found that the difference in AUC values in the two models was not statistically significant (P = .104).

In the validation group, the model with an albumin level less than 3.5 g/dL, previous HE and minimal HE according to the PHES as the three variables had an AUC of 0.71 (95% CI, 0.58-0.94) whereas the model that included just low albumin level and previous HE had an AUC of 0.69 (95% CI, 0.56-0.92). Both the prediction and validation models were validated in the independent group of patients for the three variables (AUC, 0.74; 95% CI, 0.66-0.83) and two variables (AUC, 0.71; 95% CI, 0.63-0.78), according to the study.

“This study suggests that the occurrence of overt HE may be predicted,” the researchers concluded. “The identification of patients at risk for HE may help in planning studies on the pharmacologic prevention of HE. Moreover, patients at risk may benefit from more frequent reviews, education, and support of caregivers, prevention of falls, driving advice and accurate counseling on HE precipitants.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.