title: A Model for Predicting Development of Overt Hepatic Encephalopathy in Patients With Cirrhosis.
abstract: OBJECTIVE
  Overt hepatic encephalopathy (HE) affects patients' quantity and quality of life and places a burden on families. There is evidence that overt HE might be prevented pharmacologically, but prophylaxis would be justified and cost effective only for patients at risk. We aimed to identify patients with cirrhosis at risk for overt HE.
  
  
  METHODS
  We collected data from October 2009 through December 2012 for 216 consecutive patients with cirrhosis (based on liver biopsy, 96 patients with minimal HE), admitted to the Gastroenterology Unit at the University of Rome. Patients were followed up and evaluated for an average of 14.7 ± 11.6 months; development of overt HE was recorded. We analyzed end-stage liver disease scores, shunt placement, previous overt or minimal HE, psychometric hepatic encephalopathy score (PHES), and levels of albumin, bilirubin, creatinine, and sodium to develop a prediction model. We validated the model in 112 patients with cirrhosis seen at the University of Padua and followed up for 12 ± 9.5 months.
  
  
  RESULTS
  During the follow-up period, 68 patients (32%) developed at least 1 episode of overt HE. Based on multivariate analysis, the development of overt HE was associated with previous HE, minimal HE (based on PHES), and level of albumin less than 3.5 g/dL (area under curve [AUC], 0.74). A model that excluded minimal HE but included albumin level and previous HE also identified patients who would develop overt HE (AUC, 0.71); this difference in AUC values was not statistically significant (P = .104). Both models were validated in the independent group of patients (3 variables: AUC, 0.74; 95% confidence interval, 0.66-0.83; and 2 variables: AUC, 0.71; 95% confidence interval, 0.63-0.78).
  
  
  CONCLUSIONS
  We developed and validated a model to identify patients with cirrhosis at risk for overt HE based on previous HE, albumin levels, and PHES. If PHES was not available, previous HE and albumin levels still can identify patients at risk. Psychometric evaluation is essential for patients with no history of HE. These findings should aid in planning studies of pharmacologic prevention of overt HE.
authors.affiliation: Department of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy. Electronic address: oliviero.riggio@uniroma1.it.
authors.forename: Oliviero
authors.initials: O
authors.lastname: Riggio
authors.affiliation: Department of Medicine, University of Padua, Padua, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Amodio
authors.affiliation: Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Farcomeni
authors.affiliation: Department of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Merli
authors.affiliation: Department of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Nardelli
authors.affiliation: Department of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Pasquale
authors.affiliation: Department of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Pentassuglio
authors.affiliation: Department of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Gioia
authors.affiliation: Department of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Onori
authors.affiliation: Department of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Nicole
authors.initials: N
authors.lastname: Piazza
authors.affiliation: Department of Medicine, University of Padua, Padua, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: De Rui
authors.affiliation: Department of Medicine, University of Padua, Padua, Italy.
authors.forename: Sami
authors.initials: S
authors.lastname: Schiff
authors.affiliation: Department of Medicine, University of Padua, Padua, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Montagnese
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D005260:Female; D005355:Fibrosis / Q000150:complications* / Q000473:pathology*; D005500:Follow-Up Studies; D006501:Hepatic Encephalopathy / Q000175:diagnosis*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012384:Rome
keywords: Fibrosis; Liver Disease Progression; Mental Health; Risk Analysis