Covert hepatic encephalopathy is independently associated with poor survival and increased risk of hospitalization.
Covert hepatic encephalopathy is independently associated with poor survival and increased risk of hospitalization.
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DOI：
10.1038/ajg.2014.264
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发表时间：
2014-11
影响因子：
9.8
通讯作者：
Bajaj, Jasmohan S.
中科院分区：
文献类型：
--
作者：
Patidar, Kavish R.;Thacker, Leroy R.;Wade, James B.;Sterling, Richard K.;Sanyal, Arun J.;Siddiqui, Mohammad S.;Matherly, Scott C.;Stravitz, R. Todd;Puri, Puneet;Luketic, Velimir A.;Fuchs, Michael;White, Melanie B.;Noble, Nicole A.;Unser, Ariel B.;Gilles, HoChong;Heuman, Douglas M.;Bajaj, Jasmohan S.
尽管隐性肝性脑病（CHE）在既往无明显HE（OHE）的患者中的患病率很高，但其对预测临床相关结局的独立影响尚不清楚。本研究的目的是确定CHE对既往无OHE的前瞻性随访患者中至OHE时间、住院和死亡/移植的影响。没有OHE的门诊患者被招募，并接受标准纸-笔认知成套测验进行CHE诊断。对他们进行系统随访，并使用考克斯回归分析比较CHE和无CHE患者基线时至首次OHE发生、住院（肝脏相关/无关）和移植/死亡的时间。共纳入170例肝病患者（55岁，58%男性，14年教育，终末期肝病模型（MELD 9），53%丙型肝炎病毒（HCV），20%非酒精性病因），其中56%患有CHE。整个人群随访13.0 ± 14.6个月，在此期间，30%发生了首次OHE发作，42%住院，19%发生了复合死亡/移植结局。年龄、性别、病因学、MELD评分和CHE状态被纳入考克斯回归模型，用于至首次OHE发作的时间、住院、死亡和复合死亡/移植结局。在考克斯回归分析中，尽管控制了MELD，但CHE患者在随访期间发生OHE（风险比：2.1，95%置信区间1.01 - 4.5）、住院（风险比：2.5，95%置信区间1.4 - 4.5）和死亡/移植（风险比：3.4，95%置信区间1.2 - 9.7）的风险较高。尽管控制了MELD评分，隐性HE仍与生存期恶化、住院和OHE发生风险增加相关。检测和治疗CHE的策略可能会改善这些风险。
Despite the high prevalence of covert hepatic encephalopathy (CHE) in cirrhotics without previous overt HE (OHE), its independent impact on predicting clinically relevant outcomes is unclear. The aim of this study was to define the impact of CHE on time to OHE, hospitalization, and death/transplant in prospectively followed up patients without previous OHE. Outpatient cirrhotics without OHE were enrolled and were administered a standard paper–pencil cognitive battery for CHE diagnosis. They were systematically followed up and time to first OHE development, hospitalization (liver-related/unrelated), and transplant/death were compared between CHE and no-CHE patients at baseline using Cox regression. A total of 170 cirrhotic patients (55 years, 58% men, 14 years of education, Model for End-Stage Liver Disease (MELD 9), 53% hepatitis C virus (HCV), 20% nonalcoholic etiology) were included, of whom 56% had CHE. The entire population was followed up for 13.0±14.6 months, during which time 30% developed their first OHE episode, 42% were hospitalized, and 19% had a composite death/transplant outcome. Age, gender, etiology, the MELD score, and CHE status were included in Cox regression models for time to first OHE episode, hospitalization, death, and composite death/transplant outcomes. On Cox regression, despite controlling for MELD, those with CHE had a higher risk of developing OHE (hazard ratio: 2.1, 95% confidence interval 1.01–4.5), hospitalization (hazard ratio: 2.5, 95% confidence interval 1.4–4.5), and death/transplant (hazard ratio: 3.4, 95% confidence interval 1.2–9.7) in the follow-up period. Covert HE is associated with worsened survival and increased risk of hospitalization and OHE development, despite controlling for the MELD score. Strategies to detect and treat CHE may improve these risks.
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影响因子：
29.4
作者：
Bajaj JS;Schubert CM;Heuman DM;Wade JB;Gibson DP;Topaz A;Saeian K;Hafeezullah M;Bell DE;Sterling RK;Stravitz RT;Luketic V;White MB;Sanyal AJ
通讯作者：
Sanyal AJ
影响因子：
13.5
作者：
Prasad, Srinivasa;Dhiman, Radha K.;Agarwal, Ritesh
通讯作者：
Agarwal, Ritesh
影响因子：
3.6
作者：
Shawcross, D. L.;Wright, G.;Jalan, R.
通讯作者：
Jalan, R.
影响因子：
12.6
作者：
Stepanova, Maria;Mishra, Alita;Younossi, Zobair M.
通讯作者：
Younossi, Zobair M.
影响因子：
13.5
作者：
Bajaj, Jasmohan S.;Hafeezullah, Muhammad;Saeian, Kia
通讯作者：
Saeian, Kia