Bristol Stool Scale as a Determinant of Hepatic Encephalopathy Management in Patients With Cirrhosis.
Bristol Stool Scale as a Determinant of Hepatic Encephalopathy Management in Patients With Cirrhosis.
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DOI：
10.14309/ajg.0000000000001550
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发表时间：
2022-02-01
期刊：
影响因子：
--
通讯作者：
Bajaj JS
中科院分区：
文献类型：
--
作者：
Duong NK;Shrestha S;Park D;Shahab O;Fagan A;Malpaya Z;Gallagher ML;Morris A;Davis BC;Bajaj JS
用排便频率(BM)滴定乳果糖治疗肝性脑病(HE)。然而，使用Bristol大便分级(BSS，0-7)的大便一致性通常被忽略。对门诊肝硬变患者进行训练后，将BSS纳入决策。2~3BMS/天和BSS 3~4被认为是正常的，其余的被认为是高或低；评价指标之间的一致性。比较两组患者的用药变化和6个月的入院情况。对所有入院患者和与HE相关的患者进行一致性和回归分析，并对HE相关的用药稳定性进行比较。对两次就诊的门诊患者进行血瘀证和血气分析。血瘀证和血瘀证的符合率为46%，血瘀证和血瘀证的相关性为中等(r=0.27p=0.005)。与治疗前相比，6个月的入院总数(4%vs.36%，p<；0.001)或与HE相关的入院率(1%vs.12%，p=0.002)较低。回归分析显示MELD(OR：1.1 0，p=0.003)和入院前/后(OR：0.0 4，p<；0.001)与HE相关的入院(OR：3.5 9，p=0.0 4)和前/后(OR：0.16，p=0.0 2)显著相关。血瘀证患者血瘀证及血瘀证患者血瘀证治疗后较血瘀证前稳定(32%比20%，p=0.04)。33例无药物变化或基础临床状态改变的患者，相隔36±24天进行测试。BSS(p=0.73)和BMS(p=0.19)无明显变化。BSS是肠道运动频率的补充和补充，可以调节再次住院的风险，稳定门诊肝硬化患者与HE相关的治疗变化，并有助于个性化HE管理。
Bowel movement frequency (BM) is used to titrate lactulose for hepatic encephalopathy (HE). However, stool consistency using the Bristol stool scale (BSS, 0–7) is often ignored. BSS was incorporated into decision-making after training in outpatients with cirrhosis. 2–3BMs/day and BSS 3–4 were considered normal while the rest were considered high or low; concordance between the metrics was evaluated. Medication changes and 6-month admissions were compared between this group (post-BSS) to a comparable previous group (pre-BSS). Concordance and regression analyses for all and HE-related admissions were performed, and comparisons were made for HE-related medication stability. An outpatient group seen twice was analyzed for BSS and BMs. Post-BSS, 112 patients were included with only 46% BSS and BMs concordance and modest BSS/BMs correlation (r=0.27,p=0.005). Compared to a pre-BSS cohort (N=114) there was a lower 6-month total (4% vs.36%,p<0.001) or HE-related admission(1% vs.12%,p=0.002). Regression showed MELD (OR:1.10,p=0.003) and pre/post-BSS (OR:0.04,p<0.001) for all admissions and HE (OR:3.59,p=0.04) and Pre/post (OR:0.16,p=0.02) for HE-related admissions as significant. HE-medication regimens were more stable post-BSS vs pre-BSS (32% vs 20%,p=0.04), which was due to patients with BSS>BMs (p=0.02). 33 patients without medication changes or underlying clinical status changes were tested 36±24 days apart. No change in BSS(p=0.73) or BMs (p=0.19) were found. BSS is complementary and additive to bowel movement frequency, can modulate the risk of readmissions and stabilize HE-related therapy changes in outpatients with cirrhosis, and could help personalize HE management.
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影响因子：
3.3
作者：
Riegler, G;Esposito, I
通讯作者：
Esposito, I
影响因子：
7.6
作者：
Blake, M. R.;Raker, J. M.;Whelan, K.
通讯作者：
Whelan, K.
影响因子：
9.8
作者：
Volk, Michael L.;Fisher, Natalie;Fontana, Robert J.
通讯作者：
Fontana, Robert J.
影响因子：
9.4
作者：
Caroff, Daniel A.;Edelstein, Paul H.;Pegues, David A.
通讯作者：
Pegues, David A.
DOI：
10.1002/hep.28414
发表时间：
2016-07
期刊：
Hepatology (Baltimore, Md.)
影响因子：
--
作者：
Bajaj JS;Reddy KR;Tandon P;Wong F;Kamath PS;Garcia-Tsao G;Maliakkal B;Biggins SW;Thuluvath PJ;Fallon MB;Subramanian RM;Vargas H;Thacker LR;O'Leary JG;North American Consortium for the Study of End-Stage Liver Disease
通讯作者：
North American Consortium for the Study of End-Stage Liver Disease