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Prognostic significance of hepatic encephalopathy in patients with cirrhosis

J Bustamante1, A Rimola, P J Ventura

  • 1Liver Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, University of Barcelona, Spain.

Journal of Hepatology
|June 12, 1999
PubMed

Insights

Hepatic encephalopathy significantly shortens survival in cirrhosis patients. A prognostic index identifies high-risk individuals, underscoring the need for early liver transplant consideration.

Area of Science:

  • Hepatology
  • Gastroenterology
  • Clinical Prognosis

Background:

  • Cirrhosis prognosis is well-studied, aiding liver transplant selection.
  • Hepatic encephalopathy is a frequent complication with under-explored prognostic significance.

Purpose of the Study:

  • Determine survival probability in cirrhotic patients with acute hepatic encephalopathy.
  • Identify prognostic factors for survival in this patient group.

Main Methods:

  • Retrospective chart review of 111 cirrhotic patients with a first episode of acute hepatic encephalopathy.
  • Univariate and multivariate analyses to identify significant prognostic factors.
  • Development of a prognostic index based on 7 clinical and laboratory variables.

Main Results:

  • 82% of patients died during follow-up; 1-year and 3-year survival rates were 42% and 23%, respectively.
  • Poor prognosis associated with male sex, elevated bilirubin, alkaline phosphatase, BUN, and decreased albumin and prothrombin activity.
  • Prognostic index differentiated survival: 1-year survival 73% (low index) vs. 10% (high index).

Conclusions:

  • Acute hepatic encephalopathy indicates poor survival in cirrhosis patients.
  • Prognostic index stratifies risk, but all groups show lower survival than post-transplant.
  • Urgent consideration for liver transplantation is recommended for cirrhotic patients with acute hepatic encephalopathy.
Abstract

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