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Prospective Multicenter Observational Study of Overt Hepatic Encephalopathy.

C S Landis1, M Ghabril2, V Rustgi3

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Summary

Overt hepatic encephalopathy (OHE) frequently recurs, causing significant healthcare burdens. Confusion and altered mental status are common symptoms, highlighting an unmet medical need despite rifaximin use.

Keywords:
Altered mental statusChronic liver diseaseCirrhosisClinical trialHealth-care burdenLiver failurePharmacoeconomics

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Area of Science:

  • Hepatology
  • Gastroenterology
  • Internal Medicine

Background:

  • Overt hepatic encephalopathy (OHE) is a common complication in patients with decompensated cirrhosis.
  • Cirrhosis management often involves addressing OHE and its associated complications.

Purpose of the Study:

  • To identify the most frequent presenting symptoms of OHE.
  • To evaluate the healthcare burden associated with OHE, including recurrence and hospitalizations.

Main Methods:

  • A multicenter prospective observational study enrolled 265 patients with OHE.
  • Patients were followed for up to 9 months to record OHE recurrence and manifestations.

Main Results:

  • The most common OHE manifestations were confusion (78%), altered mental status (57%), disorientation (48%), lethargy (46%), and asterixis (45%).
  • Seventy-two patients experienced 122 OHE episodes, with 23 patients accounting for 60% of recurrences.
  • Most episodes occurred while on rifaximin and were associated with hospitalization (68-85%).

Conclusions:

  • OHE presents with common neurological symptoms like confusion and altered mental status.
  • Frequent OHE recurrence and hospitalizations indicate a significant unmet medical need and healthcare burden, even with rifaximin treatment.