Early prediction of short-term development of hepatic encephalopathy in patients with acute liver disease unrelated to paracetamol. A prospective study in Japan.
OBJECTIVE
The aim of our study was to provide a predictive model for early recognition of the risk of short-term development of hepatic encephalopathy (HE) in patients with symptomatic acute liver disease (ALD).


METHODS
From a retrospective analysis of 220 patients with ALD, prothrombin time (PT) equal to, or lower than, 80% of normal, was set as the registration criteria in the subsequent patient cohorts of the study. Then, a HE-prediction model was derived by a logistic regression analysis of data in 259 new patients, and prospectively validated in 124 other patients, both groups of patients were affected by ALD unrelated to paracetamol (non-P ALD).


RESULTS
The following HE-prediction model was established: lambda = [0.692 x ln(1 + total bilirubin(mg/dL))] - 0.065 x PT(%) + [1.388 x Age(years)] + [0.868 x Etiology] - 1.156, where Age is 1 in patients older than 50 years and Etiology is 1 when the cause of non-P ALD is flare-up of type B hepatitis, auto-immune hepatitis or unknown, and 0 otherwise. In the validation group, according to the model-based risk of subsequent development of HE, sensitivity and specificity of the model were 100% and 69.0%, respectively, in patients with an evaluated risk lower than 20%, and 62.5% and 93.1%, respectively, in those with an evaluated risk equal to, or greater than, 50%.


CONCLUSIONS
In Japanese patients with symptomatic non-P ALD, our model, which includes four of the five items used in the King's College Hospital criteria, represents an acceptable, effective model to allow early detection of the risk of short-term development of HE. Using this model in other populations requires further validation specific to each of them.
Department of Gastroenterology and Hepatology, Open Research Center, Advanced Medical Science Center Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Japan. ytakikaw@iwate-med.ac.jp
Yasuhiro
Y
Takikawa
Ryujin
R
Endo
Kazuyuki
K
Suzuki
Hirohito
H
Tsubouchi
D000082:Acetaminophen / Q000009:adverse effects; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology* / Q000401:mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D017114:Liver Failure, Acute / Q000150:complications* / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D013997:Time Factors
D000082:Acetaminophen