Prognostic significance of hepatic encephalopathy in patients with cirrhosis.
BACKGROUND
There are numerous studies concerning the natural history and prognostic factors in cirrhosis, the results of which are useful in selecting liver transplant candidates. However, little attention has been paid to the prognostic significance of hepatic encephalopathy despite the high frequency of this complication.


METHODS
We reviewed the charts of 111 cirrhotic patients who developed a first episode of acute hepatic encephalopathy to determine their survival probability and to identify prognostic factors.


RESULTS
During follow-up (12+/-17 months), 82 (74%) patients died. The survival probability was 42% at 1 year of follow-up and 23% at 3 years. With univariate analyses followed by a multivariate analysis, 7 out of 30 clinical and standard laboratory variables were significantly associated with poor prognosis: male sex, increased serum bilirubin, alkaline phosphatase, potassium and blood urea nitrogen, and decreased serum albumin and prothrombin activity. Patients were classified into two groups according to a prognostic index calculated from these 7 variables. Survival probability at 1 and 3 years was 73% and 38%, respectively, in patients with a low prognostic index, and 10% and 3% in patients with a high prognostic index.


CONCLUSIONS
Hepatic encephalopathy is associated with short survival in cirrhotic patients. Although these patients can be classified into several groups with a different prognosis, the survival probability in every group is lower than that currently expected after liver transplantation. Therefore, cirrhotic patients developing a first episode of acute hepatic encephalopathy should be considered as potential candidates for this therapeutic procedure.
Bustamante
J
J
Liver Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, University of Barcelona, Spain.
Rimola
A
A
Ventura
P J
PJ
Navasa
M
M
Cirera
I
I
Reggiardo
V
V
Rodés
J
J
D000469:Alkaline Phosphatase / Q000097:blood; D000704:Analysis of Variance; D001663:Bilirubin / Q000097:blood; D001806:Blood Urea Nitrogen; D005260:Female; D005500:Follow-Up Studies; D006501:Hepatic Encephalopathy / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D015999:Multivariate Analysis; D011188:Potassium / Q000097:blood; D011336:Probability; D011379:Prognosis; D011516:Prothrombin / Q000032:analysis; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D015996:Survival Rate; D013997:Time Factors
D012709:Serum Albumin; D011516:Prothrombin; D000469:Alkaline Phosphatase; D001663:Bilirubin; D011188:Potassium