Association between anticholinergic drug use and hepatic encephalopathy risk among patients with cirrhosis

Anticholinergic drugs reduce gastric acid production and induce constipation, both of which are associated with gut dysbiosis. Medication-induced changes in gut flora may lead to hepatic encephalopathy in patients with cirrhosis. This study aimed to evaluate the association between anticholinergic drug use and the risk of hepatic encephalopathy among patients with cirrhosis.

This retrospective cohort study included patients with cirrhosis (age ≥20 years), identified from the Health and Welfare Database in Taiwan with the study period from 2007 to 2018. The included patients were categorized into two groups: anticholinergic drug users-those who received oral anticholinergic drugs with continuous refills without a gap of 28 days over a 180-day exposure period-and nonusers. The outcome was the incidence of hepatic encephalopathy. To address confounding effects, we performed propensity score matching and inverse probability of treatment weighting. Using Cox proportional-hazard regression models, we investigated the association between anticholinergic drug use and hepatic encephalopathy risk among patients with cirrhosis.

The study cohort included 10,607 cirrhotic patients; of them, 33.8 % were anticholinergic drug users. Among these patients, anticholinergic drug users were found to be associated with a significantly increased risk of hepatic encephalopathy (adjusted hazard ratio: 2.59: 95 % confidence interval: 1.77-3.80).

Anticholinergic drug users were at a significantly higher risk of hepatic encephalopathy among patients with cirrhosis in Taiwan. Thus, anticholinergic drugs should be prescribed cautiously, and the cognitive performance of patients with cirrhosis who use these drugs should be monitored regularly.