Novel predictive model accurately predicts risk of hepatic encephalopathy in cirrhosis

Bedside measures including activity, quality of life and physical function accurately predicted the risk for overt hepatic encephalopathy in patients with cirrhosis, according to results published in The American Journal of Gastroenterology.

“In this prospective study, we define the incidence of overt [hepatic encephalopathy (HE)] in a large cohort with cirrhosis and portal hypertension,” Elliot B. Tapper, MD, from the division of gastroenterology and hepatology, department of internal medicine at the University of Michigan in Ann Arbor. “In addition, we established a new model to predict overt HE. [MELDNa-Actvity-Chairstands-Quality of Life Hepatic Encephalopathy Score (MASQ-HE)] could overcome the limitations of implementing psychometric measurements and expand the pool of patients who are accurately classified for their risk of HE.”

Tapper and colleagues prospectively enrolled 294 patients with Child A-B cirrhosis and portal hypertension without prior HE. The development of overt HE served as the primary outcomes. Investigators evaluated the predictive power of model for end-stage liver disease-sodium (MELD-Na), the inhibitory control test, the sickness impact profile score and the bilirubin-albumin-beta-blocker-statin score. In addition, they developed a novel predictive model which incorporates MELD-Na score, impact of cirrhosis on daily activity, frailty, and health-related quality of life.

Results showed the median MELD-Na score was 9. Investigators noted during a follow-up at 548 days that 62 patients had incident overt HE with 1-year probability of 14% ± 2%, 10% ± 2%, and 25% ± 5% for Child A and B.

“The best model for predicting the risk of overt HE included MELD-Na, Short-Form 8, impact on activity rating, and chair-stands within 30 seconds,” the authors wrote. “This model — MELDNa-actvity-chair stands-quality of life HE score — offered an area under the receiver operating curve (AUROC) for HE development at 12 months of 0.82 compared with 0.55, 0.61, 0.70, and 0.72 for the inhibitory control test, sickness impact profile, bilirubin-albumin-beta-blocker-statin, and MELD-Na, respectively.”

According to researchers, the AUROC for HE-related hospitalization was 0.92.