Patients with cirrhosis who already have had hepatic encephalopathy are at risk for developing recurrence, and its course can depend on the presence or nonpresence of acute-on-chronic liver failure, recent study results determined.
From February to September 2011, 1,348 patients with cirrhosis and acute decompensation were enrolled in the Canonic Study, a prospective, observational, multicenter, international investigation in Europe. Acute-on-chronic liver failure (ACLF) was diagnosed in 301 patients, and hepatic encephalopathy (HE), a typical complication in patients with cirrhosis, also was present in 460 patients. HE was designated as mild (grade I or II) or severe (grade III or IV).
In patients without ACLF, 286 had HE, while 174 ACLF patients were diagnosed with HE. Patients with HE that was not associated with ACLF tended to be older (59 ± 11.7 years vs. 54.8 ± 11.5 years; P<.001), inactive drinkers (46% vs. 57.8%; P=.016), without severe liver failure or systemic inflammatory reaction and in relation to diuretic use. Among those with HE and associated ACLF, patients were younger (54.8 ± 11.5 years vs. 56.7 ± 11.4 years), more frequently alcoholic and with severe liver failure and inflammatory reaction.
The researchers said patients previously diagnosed with HE were most at risk to have it again. Of the patients who had HE at study enrollment, 53.6%% had previous HE compared with 20.8% of those without previous HE at study start.
“HE is not a homogenous disorder,” the researchers concluded. “It is useful to separate those with HE as an effect of diuretics from those with HE as a manifestation of ACLF, characterized by severe liver failure, acute inflammatory reaction and organ failure(s).”
Disclosure: Researcher Juan Cordoba, MD, has served as a consultant to Ocera and Vital Therapies.