title: Characteristics, risk factors, and mortality of cirrhotic patients hospitalized for hepatic encephalopathy with and without acute-on-chronic liver failure (ACLF).
abstract: OBJECTIVE
  In spite of the high incidence of hepatic encephalopathy (HE) in cirrhosis, there are few observational studies.
  
  
  METHODS
  We performed an analysis to define the characteristics of HE and associated features using the database of the Canonic Study. Clinical, laboratory and survival data of 1348 consecutive cirrhotic patients admitted with an acute decompensation were compared according to the presence (n=406) or absence of HE and of acute-on-chronic liver failure (ACLF) (n=301).
  
  
  RESULTS
  HE development was independently associated with previous HE episodes; survival probabilities worsen in relation to the presence and grade of HE. There were marked differences between HE associated (n=174) and not associated (n=286) to ACLF. HE not associated with ACLF occurred in older cirrhotics, inactive drinkers, without severe liver failure or systemic inflammatory reaction and in relation to diuretic use. In contrast, HE associated with ACLF occurred in younger cirrhotics, more frequently alcoholics, with severe liver failure and systemic inflammatory reaction, and in relation to bacterial infections, active alcoholism and/or dilutional hyponatremia. Prognosis was relatively preserved in the first and extremely poor in the second group. Independent risk factors of mortality in patients with HE were age, bilirubin, INR, creatinine, sodium, and HE grade.
  
  
  CONCLUSIONS
  In cirrhosis, previous HE identifies a subgroup of patients that is especially vulnerable for developing new episodes of HE. The course of HE appears to be different according to the presence of ACLF.
authors.affiliation: Hospital Vall d'Hebron, Department of Medicine, Liver Unit, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain. Electronic address: jcordoba@vhebron.net.
authors.forename: Juan
authors.initials: J
authors.lastname: Cordoba
authors.affiliation: Hospital Vall d'Hebron, Department of Medicine, Liver Unit, Universitat Autònoma de Barcelona, Spain.
authors.forename: Meritxell
authors.initials: M
authors.lastname: Ventura-Cots
authors.affiliation: Hospital Vall d'Hebron, Department of Medicine, Liver Unit, Universitat Autònoma de Barcelona, Spain.
authors.forename: Macarena
authors.initials: M
authors.lastname: Simón-Talero
authors.affiliation: Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain; Data Management Centre, EASL-CLIF Consortium, Hospital Clinic, Spain.
authors.forename: Àlex
authors.initials: À
authors.lastname: Amorós
authors.affiliation: Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain; Data Management Centre, EASL-CLIF Consortium, Hospital Clinic, Spain.
authors.forename: Marco
authors.initials: M
authors.lastname: Pavesi
authors.affiliation: Department of Hepatology and Gastroenterology, Aarhus University Hosptial, Denmark.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Vilstrup
authors.affiliation: Department of Medicine, Unit of Hepatic Emergencies and Liver Transplantation, University of Padova, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Angeli
authors.affiliation: Semeiotica Medica, Policlinico S. Orsola-Malpighi, Department of Medical and Surgical Sciences, University of Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Domenicali
authors.affiliation: Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain; Hospital Clínic, Liver Unit, University of Barcelona IDIBAPS, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Ginés
authors.affiliation: Semeiotica Medica, Policlinico S. Orsola-Malpighi, Department of Medical and Surgical Sciences, University of Bologna, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Bernardi
authors.affiliation: Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain; Hospital Clínic, Liver Unit, University of Barcelona IDIBAPS, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Arroyo
mesh_terms: D000368:Aged; D058625:End Stage Liver Disease / Q000150:complications / Q000401:mortality; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology* / Q000401:mortality*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality*; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000401:mortality; D017114:Liver Failure, Acute / Q000150:complications* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors
keywords: (CLIF); ACLF; ALT; AST; Acute-on-chronic liver failure; Cirrhosis; EASL-Chronic Liver Failure; GGT; HE; Hepatic encephalopathy; INR; International Normalized Ratio; MELD; Risk factors; SOFA; Sequential Organ Failure Assessment; WBC; acute-on-chronic liver failure; alanine aminotransferase; aspartate aminotransferase; gamma-glutamyl transferase; hepatic encephalopathy; international normalized ratio; model for end-stage liver disease; n.s.; non significant; white blood cells