title: Epilepsy as a risk factor for hepatic encephalopathy in patients with cirrhosis: a cohort study.
abstract: BACKGROUND
  Epilepsy is associated with an increased mortality among cirrhosis patients, but the reasons are unknown. We aimed to determine whether epilepsy is a risk factor for developing hepatic encephalopathy (HE), which is a strong predictor of mortality.
  
  
  METHODS
  We used data from three randomized 1-year trials of satavaptan in cirrhosis patients with ascites. With Cox regression, we compared the hazard rates of HE grade 1-4 between those cirrhosis patients who did or did not have epilepsy. We adjusted for confounding by gender, age, cirrhosis etiology, diabetes, history of HE, Model for Endstage Liver Disease (MELD) score, serum sodium, albumin, lactulose use, rifaximin use, and benzodiazepine/barbiturate sedation. In a supplementary analysis we examined the association between epilepsy and the hazard rate of HE grade 2-4.
  
  
  RESULTS
  Of the 1120 cirrhosis patients with ascites, 21 (1.9 %) were diagnosed with epilepsy. These patients had better liver function at inclusion than the patients without epilepsy (median MELD score 7.9 vs. 11.4), and only one died during the trials. Nevertheless, seven patients with epilepsy had an HE episode during the follow-up, and the adjusted hazard ratio of HE grade 1-4 for patients with epilepsy vs. controls was 2.12 (95 % CI 0.99-4.55). The corresponding hazard ratio of HE grade 2-4 was 3.83 (95 % CI 1.65-8.87).
  
  
  CONCLUSIONS
  Our findings suggest that epilepsy is associated with an increased risk of HE in patients with cirrhosis.
authors.affiliation: Department of Hepatology and Gastroenterology, Aarhus University Hospital, Nørrebrogade 44, DK-8000, Aarhus, Denmark. pj@clin.au.dk.|Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. pj@clin.au.dk.
authors.forename: Peter
authors.identifier: http://orcid.org/0000-0002-6641-1430
authors.initials: P
authors.lastname: Jepsen
authors.affiliation: Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Jakob
authors.initials: J
authors.lastname: Christensen
authors.affiliation: Department of Neurology, Hannover Medical School, Hannover, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Weissenborn
authors.affiliation: Sanofi Aventis R&D, Paris, France.
authors.forename: Hugh
authors.initials: H
authors.lastname: Watson
authors.affiliation: Department of Hepatology and Gastroenterology, Aarhus University Hospital, Nørrebrogade 44, DK-8000, Aarhus, Denmark.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Vilstrup
mesh_terms: D001201:Ascites / Q000150:complications; D004827:Epilepsy / Q000150:complications*; D005260:Female; D006501:Hepatic Encephalopathy / Q000150:complications* / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors
keywords: End-stage liver disease; Liver failure; Neurology; Prognosis; Seizures