Frontiers in Medicine (May 2023)
Hepatic encephalopathy increases the risk for mortality and hospital readmission in decompensated cirrhotic patients: a prospective multicenter study
- Oliviero Riggio,
- Oliviero Riggio,
- Ciro Celsa,
- Ciro Celsa,
- Vincenza Calvaruso,
- Manuela Merli,
- Paolo Caraceni,
- Paolo Caraceni,
- Sara Montagnese,
- Vincenzina Mora,
- Martina Milana,
- Giorgio Maria Saracco,
- Giovanni Raimondo,
- Antonio Benedetti,
- Patrizia Burra,
- Rodolfo Sacco,
- Marcello Persico,
- Filippo Schepis,
- Erica Villa,
- Antonio Colecchia,
- Antonio Colecchia,
- Stefano Fagiuoli,
- Stefano Fagiuoli,
- Mario Pirisi,
- Mario Pirisi,
- Michele Barone,
- Francesco Azzaroli,
- Giorgio Soardo,
- Giorgio Soardo,
- Maurizio Russello,
- Filomena Morisco,
- Sara Labanca,
- Anna Ludovica Fracanzani,
- Anna Ludovica Fracanzani,
- Antonello Pietrangelo,
- Gabriele Di Maria,
- Silvia Nardelli,
- Lorenzo Ridola,
- Antonio Gasbarrini,
- Calogero Cammà
Affiliations
- Oliviero Riggio
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
- Oliviero Riggio
- Department of Gastroenterology, “Santa Maria Goretti” Hospital, “Sapienza” Polo Pontino, Latina, Italy
- Ciro Celsa
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
- Ciro Celsa
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- Vincenza Calvaruso
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
- Manuela Merli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
- Paolo Caraceni
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Paolo Caraceni
- Department of Medical and Surgical Sciences, Center for Biomedical Applied Research, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Sara Montagnese
- Department of Medicine, University of Padova, Padua, Italy
- Vincenzina Mora
- Medicina Interna e Gastroenterologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Martina Milana
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome, Italy
- Giorgio Maria Saracco
- 0Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy
- Giovanni Raimondo
- 1Division of Medicine and Hepatology, University Hospital of Messina, Messina, Italy
- Antonio Benedetti
- 2Department of Gastroenterology and Hepatology, Università Politecnica delle Marche, Ancona, Italy
- Patrizia Burra
- 3Gastroenterology/Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
- Rodolfo Sacco
- 4Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
- Marcello Persico
- 5Internal Medicine and Hepatology Unit, Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, Salerno, Italy
- Filippo Schepis
- 6Gastroenterology Unit, Department of Medical Specialities, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
- Erica Villa
- 6Gastroenterology Unit, Department of Medical Specialities, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
- Antonio Colecchia
- 6Gastroenterology Unit, Department of Medical Specialities, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
- Antonio Colecchia
- 7Unit of Gastroenterology, Borgo Trento University Hospital, Verona, Italy
- Stefano Fagiuoli
- 8Gastroentyerology, University of Milan Bicocca, Milan, Italy
- Stefano Fagiuoli
- 9Gastroenterology, Hepatology and Transplantation Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
- Mario Pirisi
- 0Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy
- Mario Pirisi
- 1Internal Medicine Unit, Azienda Ospedaliera Universitaria (AOU) Maggiore della Carità Hospital, Novara, Italy
- Michele Barone
- 2Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, Bari, Italy
- Francesco Azzaroli
- 3Gastroenterology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Department of Surgical and Medical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Giorgio Soardo
- 4Clinic of Internal Medicine-Liver Unit, Department of Medical Area (DAME), University of Udine, Udine, Italy
- Giorgio Soardo
- 5Italian Liver Foundation, Area Science Park, Trieste, Italy
- Maurizio Russello
- 6Liver Unit, Azienda di Rilievo Nazionale ed Alta Specializzazione (ARNAS) Garibaldi-Nesima, Catania, Italy
- Filomena Morisco
- 7Gastroenterology and Hepatology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
- Sara Labanca
- 8Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- Anna Ludovica Fracanzani
- 9Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Anna Ludovica Fracanzani
- 0General Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Antonello Pietrangelo
- 1Department of Internal and Emergency Medicine, University Hospital of Modena, Modena, Italy
- Gabriele Di Maria
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
- Silvia Nardelli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
- Lorenzo Ridola
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
- Antonio Gasbarrini
- Medicina Interna e Gastroenterologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Calogero Cammà
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
- DOI
- https://doi.org/10.3389/fmed.2023.1184860
- Journal volume & issue
-
Vol. 10
Abstract
IntroductionHepatic encephalopathy (HE) affects the survival and quality of life of patients with cirrhosis. However, longitudinal data on the clinical course after hospitalization for HE are lacking. The aim was to estimate mortality and risk for hospital readmission of cirrhotic patients hospitalized for HE.MethodsWe prospectively enrolled 112 consecutive cirrhotic patients hospitalized for HE (HE group) at 25 Italian referral centers. A cohort of 256 patients hospitalized for decompensated cirrhosis without HE served as controls (no HE group). After hospitalization for HE, patients were followed-up for 12 months until death or liver transplant (LT).ResultsDuring follow-up, 34 patients (30.4%) died and 15 patients (13.4%) underwent LT in the HE group, while 60 patients (23.4%) died and 50 patients (19.5%) underwent LT in the no HE group. In the whole cohort, age (HR 1.03, 95% CI 1.01–1.06), HE (HR 1.67, 95% CI 1.08–2.56), ascites (HR 2.56, 95% CI 1.55–4.23), and sodium levels (HR 0.94, 95% CI 0.90–0.99) were significant risk factors for mortality. In the HE group, ascites (HR 5.07, 95% CI 1.39–18.49) and BMI (HR 0.86, 95% CI 0.75–0.98) were risk factors for mortality, and HE recurrence was the first cause of hospital readmission.ConclusionIn patients hospitalized for decompensated cirrhosis, HE is an independent risk factor for mortality and the most common cause of hospital readmission compared with other decompensation events. Patients hospitalized for HE should be evaluated as candidates for LT.
Keywords
- hepatic encephalopathy
- decompensated cirrhosis
- orthotopic liver transplant
- hospital readmission
- mortality
