Predicting Hepatic Encephalopathy-Related Hospitalizations Using a Composite Assessment of Cognitive Impairment and Frailty in 355 Patients With Cirrhosis
Predicting Hepatic Encephalopathy-Related Hospitalizations Using a Composite Assessment of Cognitive Impairment and Frailty in 355 Patients With Cirrhosis
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DOI：
10.1038/s41395-018-0243-0
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发表时间：
2018-10-01
影响因子：
9.8
通讯作者：
Tandon, Puneeta
中科院分区：
文献类型：
--
作者：
Ney, Michael;Tangri, Navdeep;Tandon, Puneeta
前言：肝性脑病(HE)是肝硬变患者最常见的潜在可改变的入院原因。脆弱的认知和身体成分具有作为HE危险因素的病理生理学基础。我们的目的是评估使用蒙特利尔认知评估(MoCA)和临床脆弱量表(CFS)开发的综合评分(MoCA-CFS)在预测6个月内入院的HE患者中的应用。方法：连续6个月的成年肝硬化患者被跟踪6个月或直到死亡/移植。排除有明确肝性脑病和痴呆的患者。结果：共纳入355例患者，平均年龄55.9+/-9.6岁，男性占62.5%，丙型肝炎和酒精病因占的62.5%。36%的患者有认知障碍，根据MoCA(=24)，14%的患者在CFS(>；4)上虚弱。MoCA-CFS独立预测6个月内住院，MoCA-CFS评分为1分和2分分别使住院几率增加3.3(95%CI：1.5~7.7)和5.7(95%CI：1.9~17.3)。HRQOL随MoCA-CFS的增加而降低。抑郁和高龄是低MOCA的独立预测因素。结论：认知和身体虚弱在肝硬变患者中很常见。除了是6个月内HE入院的独立预测因子外，MoCA-CFS综合评分还预测6个月内HRQL受损和全因入院。这些数据支持“多维”脆弱工具在预测不良临床结果方面的预测价值，并突出了以认知障碍、身体虚弱和抑郁为目标的多方面治疗方法的潜力。
INTRODUCTION: Hepatic encephalopathy (HE) is the most common potentially modifiable reason for admission in patients with cirrhosis. Cognitive and physical components of frailty have pathophysiologic rationale as risk factors for HE. We aimed to assess the utility of a composite score (MoCA-CFS) developed using the Montreal Cognitive Assessment (MoCA) and the Clinical Frailty Scale (CFS) for predicting HE admissions within 6 months.METHODS: Consecutive adult patients with cirrhosis were followed for 6 months or until death/transplant. Patients with overt HE and dementia were excluded. Primary outcome was the prediction of HErelated admissions at 6 months.RESULTS: A total of 355 patients were included; mean age 55.9 +/- 9.6; 62.5% male; Hepatitis C and alcohol etiology in 64%. Thirty-six percent of patients had cognitive impairment according to the MoCA (= 24) and 14% were frail on the CFS (> 4). The MoCA-CFS independently predicted HE hospitalization within 6 months, a MoCA-CFS score of 1 and 2 respectively increasing the odds of hospitalization by 3.3 (95% CI: 1.5-7.7) and 5.7 (95% CI: 1.9-17.3). HRQoL decreased with increasing MoCA-CFS. Depression and older age were independent predictors of a low MoCA.CONCLUSIONS: Cognitive and physical frailty are common in patients with cirrhosis. In addition to being an independent predictor of HE admissions within 6 months, the MoCA-CFS composite score predicts impaired HRQoL and all-cause admissions within 6 months. These data support the predictive value of a "multidimensional" frailty tool for the prediction of adverse clinical outcomes and highlight the potential for a multi-faceted approach to therapy targeting cognitive impairment, physical frailty and depression.