Autoren:	Gairing, Simon Johannes Mangini, Chiara Zarantonello, Lisa Gioia, Stefania Nielsen, Elise Jonasson Danneberg, Sven Lok, Anna S. Sultanik, Philippe Galle, Peter Robert Labenz, Joachim Thabut, Dominique Marquardt, Jens Uwe Bloom, Patricia P. Lauridsen, Mette Munk Montagnese, Sara Nardelli, Silvia Labenz, Christian
Titel:	Minimal hepatic encephalopathy is associated with a higher risk of overt hepatic encephalopathy and poorer survival
Online-Publikationsdatum:	17-Jan-2024
Erscheinungsdatum:	2023
Sprache des Dokuments:	Englisch
Zusammenfassung/Abstract:	Background and aims Minimal hepatic encephalopathy (MHE) is a frequent complication in patients with liver cirrhosis. Its impact on predicting the development of overt hepatic encephalopathy (OHE) and survival has not been studied in large multicenter studies. Methods Data from patients recruited at eight centers across Europe and the United States were analyzed. MHE was detected using the psychometric hepatic encephalopathy score (PHES). A subset was also tested with the simplified animal naming test (S-ANT1). Patients were followed for OHE development and death/liver transplantation (LTx). Results A total of 1462 patients with a median model of end-stage liver disease of 11 were included (Child-Pugh (CP) stages: A 47%/B 41%/C 12%). Median follow-up time was 19 months, during which 336 (23%) patients developed an OHE episode and 464 (32%) reached the composite end point of death/LTx (369 deaths, 95 LTx). In multivariable analyses, MHE (defined by PHES) was associated with the development of OHE (subdistribution hazard ratio 1.74, p < 0.001) and poorer LTx-free survival (hazard ratio 1.53, p < 0.001) in the total cohort as well as in the subgroup of patients without a history of OHE. In subgroup analyses, MHE (defined by PHES) was associated with OHE development in patients with CP B, whereas there was no association in patients with CP A or C. In the subgroup of patients with available S-ANT1, MHE (defined by S-ANT1) was independently associated with OHE development. Combined testing (PHES+S-ANT1) was superior to single testing for predicting OHE and poorer LTx-free survival. Conclusions This large multicenter study demonstrates that screening for MHE is a useful tool for predicting OHE and poorer survival.
DDC-Sachgruppe:	610 Medizin 610 Medical sciences
Veröffentlichende Institution:	Johannes Gutenberg-Universität Mainz
Organisationseinheit:	FB 04 Medizin
Veröffentlichungsort:	Mainz
ROR:	https://ror.org/023b0x485
DOI:	http://doi.org/10.25358/openscience-9782
Version:	Published version
Publikationstyp:	Zeitschriftenaufsatz
Nutzungsrechte:	CC BY-NC-ND
Informationen zu den Nutzungsrechten:	https://creativecommons.org/licenses/by-nc-nd/4.0/
Zeitschrift:	Journal of internal medicine Version of Record (VoR)
Verlag:	Wiley-Blackwell
Verlagsort:	Oxford u.a
Erscheinungsdatum:	2023
ISSN:	0954-6820
DOI der Originalveröffentlichung:	10.1111/joim.13747
Enthalten in den Sammlungen:	DFG-491381577-H