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Composite score predicts hepatic encephalopathy admission

The MoCA-CFS composite score — developed using the Montreal Cognitive Assessment and the Clinical Frailty Scale — independently predicted hospital admissions for hepatic encephalopathy and impaired health-related quality of life among patients with cirrhosis, according to recently published data.

“There is a clinical need to identify more practical screens that can assist us to determine which patients are at high risk of short-term [hepatic encephalopathy (HE)]-related hospital admissions,” Michael Ney, MD, from the University of Alberta in Canada, and colleagues wrote. “Once identified, management of these high-risk patients can be intensified in an attempt to reduce admission rates and the associated healthcare costs.”

The study comprised 355 patients with cirrhosis. Assessment showed that 59% of the participating patients had a MoCA-CFS composite score of 0 (normal on both), 33% had a score of 1 (abnormal MoCA or CFS results), and 8% had a composite score of 2 (abnormal on both).

HE-related hospitalizations over 6 months of follow-up increased in frequency as MoCA-CFS scores increased, with 7.7% of those who scored 0, 15.3% of those who scored 1, and 31% of those who scored 2 requiring admission.

Multivariate analysis showed that both MoCA-CFS score 1 (OR = 3.3; 95% CI, 1.5-7.7) and score 2 (OR = 5.7; 95% CI, 1.9-17.3) independently increased the risk for HE-related hospitalizations.

Regarding secondary outcomes, the researchers found that the rates of death or unplanned hospital admission occurred more frequently as MoCA-CFS scores increased, especially among patients with a score of 2 (OR = 3.7; 95% CI, 1.5-9.3).

Additionally, increasing MoCA-CFS composite score correlated with decreased health-related quality of life as measured by the EuroQol-visual analog scale (P = .003) and the Chronic Liver Disease Questionnaire (P = .01).

“These data support consideration of a more ‘multidimensional’ combination of physical frailty and cognitive impairment for the prediction of adverse clinical outcomes in cirrhosis,” Ney and colleagues wrote. “We anticipate that future studies will demonstrate the benefits of a multi-faceted approach to therapy in high-risk patients, targeting the potentially modifiable factors of depressive symptoms, cognitive impairment and physical frailty.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.