title: Hepatic Encephalopathy Is Associated With Mortality in Patients With Cirrhosis Independent of Other Extrahepatic Organ Failures.
abstract: OBJECTIVE
  Although survival times have increased for patients with cirrhosis, hepatic encephalopathy (HE) remains a major complication and its relative contribution toward mortality in North America is unclear. We investigated whether HE is associated with mortality independent of extrahepatic organ failures (EHOFs).
  
  
  METHODS
  We collected data from the North American Consortium for Study of End-stage Liver Disease database of hospitalized patients with cirrhosis at tertiary-care centers. EHOFs were defined as need for ventilation (respiratory failure), dialysis (renal failure), or shock (circulatory failure). We analyzed in-hospital and 30-day mortality for patients with varying HE grades and EHOF using adjusted models.
  
  
  RESULTS
  We analyzed data from 1560 patients, 516 with HE (371 grade 1-2 and 145 grade 3-4). Patients with maximum HE grade 3-4 HE during hospitalization had a higher median model for end-stage liver disease (MELD) score (22) than patients with HE grade 1-2 (MELD score, 19) or no HE (MELD score, 18) (P < .0001). Thirty-day mortality for patients with HE grade 3-4 was significantly higher (38%) than for patients with HE grade 1-2 (8%) or no HE (7%). A total of 107 patients had 2 or more EHOFs, with or without HE; 151 had 1 EHOF and 1302 had no organ failure. Unadjusted mortality was highest for patients with HE of grade 3-4 with 2 EHOFs (n = 44). On regression analysis, HE severity was significantly associated with in-hospital and 30-day mortality, independent of any EHOF, white blood cell count, systemic inflammatory response syndrome, or MELD score (odds ratio, 3.3; P < .0001).
  
  
  CONCLUSIONS
  In an analysis of more than 1500 patients hospitalized for cirrhosis, HE of grade 3 or 4 was associated with higher in-hospital and 30-day mortality, independently of failure of other organs.
authors.affiliation: Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia. Electronic address: jsbajaj@vcu.edu.
authors.forename: Jasmohan S
authors.initials: JS
authors.lastname: Bajaj
authors.affiliation: Baylor University Medical Center, Dallas, Texas.
authors.forename: Jacqueline G
authors.initials: JG
authors.lastname: O'Leary
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Puneeta
authors.initials: P
authors.lastname: Tandon
authors.affiliation: University of Toronto, Toronto, Ontario, Canada.
authors.forename: Florence
authors.initials: F
authors.lastname: Wong
authors.affiliation: Yale University, New Haven, Connecticut.
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Garcia-Tsao
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Kamath
authors.affiliation: University of Rochester, Rochester, New York.
authors.forename: Benedict
authors.initials: B
authors.lastname: Maliakkal
authors.affiliation: University of Colorado, Denver, Colorado.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Biggins
authors.affiliation: Mercy Medical Center, Baltimore, Maryland.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Thuluvath
authors.affiliation: University of Texas, Houston, Texas.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Fallon
authors.affiliation: Emory University, Atlanta, Georgia.
authors.forename: Ram M
authors.initials: RM
authors.lastname: Subramanian
authors.affiliation: Mayo Clinic, Scottsdale, Arizona.
authors.forename: Hugo E
authors.initials: HE
authors.lastname: Vargas
authors.affiliation: University of California, San Francisco, California.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lai
authors.affiliation: Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia.
authors.forename: Leroy R
authors.initials: LR
authors.lastname: Thacker
authors.affiliation: University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: K Rajender
authors.initials: KR
authors.lastname: Reddy
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006501:Hepatic Encephalopathy / Q000401:mortality*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009656:North America; D011446:Prospective Studies; D016019:Survival Analysis; D062606:Tertiary Care Centers
keywords: ACLF; Infection; NACSELD; SIRS