Hepatic Encephalopathy Is Associated With Mortality in Patients With Cirrhosis Independent of Other Extrahepatic Organ Failures

Jasmohan S. Bajaj, Jacqueline G. O'Leary, Puneeta Tandon, Florence Wong, Guadalupe Garcia-Tsao, Patrick S. Kamath, Benedict Maliakkal, Scott W. Biggins, Paul J. Thuluvath, Michael B. Fallon, Ram M. Subramanian, Hugo E. Vargas, Jennifer Lai, Leroy R. Thacker, K. Rajender Reddy

Research output: Contribution to journalArticle

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Abstract

Background & Aims Although survival times have increased for patients with cirrhosis, hepatic encephalopathy (HE) remains a major complication and its relative contribution toward mortality in North America is unclear. We investigated whether HE is associated with mortality independent of extrahepatic organ failures (EHOFs). Methods We collected data from the North American Consortium for Study of End-stage Liver Disease database of hospitalized patients with cirrhosis at tertiary-care centers. EHOFs were defined as need for ventilation (respiratory failure), dialysis (renal failure), or shock (circulatory failure). We analyzed in-hospital and 30-day mortality for patients with varying HE grades and EHOF using adjusted models. Results We analyzed data from 1560 patients, 516 with HE (371 grade 1–2 and 145 grade 3–4). Patients with maximum HE grade 3–4 HE during hospitalization had a higher median model for end-stage liver disease (MELD) score (22) than patients with HE grade 1–2 (MELD score, 19) or no HE (MELD score, 18) (P < .0001). Thirty-day mortality for patients with HE grade 3–4 was significantly higher (38%) than for patients with HE grade 1–2 (8%) or no HE (7%). A total of 107 patients had 2 or more EHOFs, with or without HE; 151 had 1 EHOF and 1302 had no organ failure. Unadjusted mortality was highest for patients with HE of grade 3–4 with 2 EHOFs (n = 44). On regression analysis, HE severity was significantly associated with in-hospital and 30-day mortality, independent of any EHOF, white blood cell count, systemic inflammatory response syndrome, or MELD score (odds ratio, 3.3; P < .0001). Conclusions In an analysis of more than 1500 patients hospitalized for cirrhosis, HE of grade 3 or 4 was associated with higher in-hospital and 30-day mortality, independently of failure of other organs.

Original languageEnglish (US)
Pages (from-to)565-574.e4
JournalClinical Gastroenterology and Hepatology
Volume15
Issue number4
DOIs
StatePublished - Apr 1 2017
Externally publishedYes

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Hepatic Encephalopathy
Fibrosis
Mortality
Infection
End Stage Liver Disease
Shock
Systemic Inflammatory Response Syndrome
North America
Leukocyte Count
Tertiary Care Centers
Respiratory Insufficiency
Renal Insufficiency
Ventilation

Keywords

  • ACLF
  • Infection
  • NACSELD
  • SIRS

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Hepatic Encephalopathy Is Associated With Mortality in Patients With Cirrhosis Independent of Other Extrahepatic Organ Failures. / Bajaj, Jasmohan S.; O'Leary, Jacqueline G.; Tandon, Puneeta; Wong, Florence; Garcia-Tsao, Guadalupe; Kamath, Patrick S.; Maliakkal, Benedict; Biggins, Scott W.; Thuluvath, Paul J.; Fallon, Michael B.; Subramanian, Ram M.; Vargas, Hugo E.; Lai, Jennifer; Thacker, Leroy R.; Reddy, K. Rajender.

In: Clinical Gastroenterology and Hepatology, Vol. 15, No. 4, 01.04.2017, p. 565-574.e4.

Research output: Contribution to journalArticle

Bajaj, JS, O'Leary, JG, Tandon, P, Wong, F, Garcia-Tsao, G, Kamath, PS, Maliakkal, B, Biggins, SW, Thuluvath, PJ, Fallon, MB, Subramanian, RM, Vargas, HE, Lai, J, Thacker, LR & Reddy, KR 2017, 'Hepatic Encephalopathy Is Associated With Mortality in Patients With Cirrhosis Independent of Other Extrahepatic Organ Failures', Clinical Gastroenterology and Hepatology, vol. 15, no. 4, pp. 565-574.e4. https://doi.org/10.1016/j.cgh.2016.09.157
Bajaj, Jasmohan S. ; O'Leary, Jacqueline G. ; Tandon, Puneeta ; Wong, Florence ; Garcia-Tsao, Guadalupe ; Kamath, Patrick S. ; Maliakkal, Benedict ; Biggins, Scott W. ; Thuluvath, Paul J. ; Fallon, Michael B. ; Subramanian, Ram M. ; Vargas, Hugo E. ; Lai, Jennifer ; Thacker, Leroy R. ; Reddy, K. Rajender. / Hepatic Encephalopathy Is Associated With Mortality in Patients With Cirrhosis Independent of Other Extrahepatic Organ Failures. In: Clinical Gastroenterology and Hepatology. 2017 ; Vol. 15, No. 4. pp. 565-574.e4.
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AU - Bajaj, Jasmohan S.

AU - O'Leary, Jacqueline G.

AU - Tandon, Puneeta

AU - Wong, Florence

AU - Garcia-Tsao, Guadalupe

AU - Kamath, Patrick S.

AU - Maliakkal, Benedict

AU - Biggins, Scott W.

AU - Thuluvath, Paul J.

AU - Fallon, Michael B.

AU - Subramanian, Ram M.

AU - Vargas, Hugo E.

AU - Lai, Jennifer

AU - Thacker, Leroy R.

AU - Reddy, K. Rajender

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N2 - Background & Aims Although survival times have increased for patients with cirrhosis, hepatic encephalopathy (HE) remains a major complication and its relative contribution toward mortality in North America is unclear. We investigated whether HE is associated with mortality independent of extrahepatic organ failures (EHOFs). Methods We collected data from the North American Consortium for Study of End-stage Liver Disease database of hospitalized patients with cirrhosis at tertiary-care centers. EHOFs were defined as need for ventilation (respiratory failure), dialysis (renal failure), or shock (circulatory failure). We analyzed in-hospital and 30-day mortality for patients with varying HE grades and EHOF using adjusted models. Results We analyzed data from 1560 patients, 516 with HE (371 grade 1–2 and 145 grade 3–4). Patients with maximum HE grade 3–4 HE during hospitalization had a higher median model for end-stage liver disease (MELD) score (22) than patients with HE grade 1–2 (MELD score, 19) or no HE (MELD score, 18) (P < .0001). Thirty-day mortality for patients with HE grade 3–4 was significantly higher (38%) than for patients with HE grade 1–2 (8%) or no HE (7%). A total of 107 patients had 2 or more EHOFs, with or without HE; 151 had 1 EHOF and 1302 had no organ failure. Unadjusted mortality was highest for patients with HE of grade 3–4 with 2 EHOFs (n = 44). On regression analysis, HE severity was significantly associated with in-hospital and 30-day mortality, independent of any EHOF, white blood cell count, systemic inflammatory response syndrome, or MELD score (odds ratio, 3.3; P < .0001). Conclusions In an analysis of more than 1500 patients hospitalized for cirrhosis, HE of grade 3 or 4 was associated with higher in-hospital and 30-day mortality, independently of failure of other organs.

AB - Background & Aims Although survival times have increased for patients with cirrhosis, hepatic encephalopathy (HE) remains a major complication and its relative contribution toward mortality in North America is unclear. We investigated whether HE is associated with mortality independent of extrahepatic organ failures (EHOFs). Methods We collected data from the North American Consortium for Study of End-stage Liver Disease database of hospitalized patients with cirrhosis at tertiary-care centers. EHOFs were defined as need for ventilation (respiratory failure), dialysis (renal failure), or shock (circulatory failure). We analyzed in-hospital and 30-day mortality for patients with varying HE grades and EHOF using adjusted models. Results We analyzed data from 1560 patients, 516 with HE (371 grade 1–2 and 145 grade 3–4). Patients with maximum HE grade 3–4 HE during hospitalization had a higher median model for end-stage liver disease (MELD) score (22) than patients with HE grade 1–2 (MELD score, 19) or no HE (MELD score, 18) (P < .0001). Thirty-day mortality for patients with HE grade 3–4 was significantly higher (38%) than for patients with HE grade 1–2 (8%) or no HE (7%). A total of 107 patients had 2 or more EHOFs, with or without HE; 151 had 1 EHOF and 1302 had no organ failure. Unadjusted mortality was highest for patients with HE of grade 3–4 with 2 EHOFs (n = 44). On regression analysis, HE severity was significantly associated with in-hospital and 30-day mortality, independent of any EHOF, white blood cell count, systemic inflammatory response syndrome, or MELD score (odds ratio, 3.3; P < .0001). Conclusions In an analysis of more than 1500 patients hospitalized for cirrhosis, HE of grade 3 or 4 was associated with higher in-hospital and 30-day mortality, independently of failure of other organs.

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