Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China.
Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China.
World J Gastroenterol. 2017 Sep 14;23(34):6321-6329. doi: 10.3748/wjg.v23.i34.6321.
To explore the natural history of covert hepatic encephalopathy (CHE) in absence of medication intervention.
Consecutive outpatient cirrhotic patients in a Chinese tertiary care hospital were enrolled and evaluated for CHE diagnosis. They were followed up for a mean of 11.2 ± 1.3 mo. Time to the first cirrhosis-related complications requiring hospitalization, including overt HE (OHE), resolution of CHE and death/transplantation, were compared between CHE and no-CHE patients. Predictors for complication(s) and death/transplantation were also analyzed.
A total of 366 patients (age: 47.2 ± 8.6 years, male: 73.0%) were enrolled. CHE was identified in 131 patients (35.8%). CHE patients had higher rates of death and incidence of complications requiring hospitalization, including OHE, compared to unimpaired patients. Moreover, 17.6% of CHE patients developed OHE, 42.0% suffered persistent CHE, and 19.8% of CHE spontaneously resolved. In CHE patients, serum albumin < 30 g/L (HR = 5.22, = 0.03) was the sole predictor for developing OHE, and blood creatinine > 133 μmol/L (HR = 4.75, = 0.036) predicted mortality. Child-Pugh B/C (HR = 0.084, < 0.001) and OHE history (HR = 0.15, = 0.014) were predictors of spontaneous resolution of CHE.
CHE exacerbates, persists or resolves without medication intervention in clinically stable cirrhosis. Triage of patients based on these predictors will allow for more cost-effect management of CHE.
探索无药物干预情况下隐匿性肝性脑病（CHE）的自然史。
连续纳入一家中国三级保健医院的门诊肝硬化患者，并评估 CHE 诊断。他们的平均随访时间为 11.2±1.3 个月。比较 CHE 患者和无 CHE 患者发生首次需要住院的肝硬化相关并发症（包括显性肝性脑病（OHE）、CHE 缓解和死亡/移植）的时间。还分析了并发症和死亡/移植的预测因素。
共纳入 366 例患者（年龄：47.2±8.6 岁，男性：73.0%）。131 例患者（35.8%）确诊为 CHE。与无损害患者相比，CHE 患者的死亡率和需要住院治疗的并发症发生率更高，包括 OHE。此外，17.6%的 CHE 患者发生 OHE，42.0%的患者持续性 CHE，19.8%的 CHE 自发缓解。在 CHE 患者中，血清白蛋白<30 g/L（HR=5.22， =0.03）是发生 OHE 的唯一预测因素，血肌酐>133 μmol/L（HR=4.75， =0.036）预测死亡率。Child-Pugh B/C（HR=0.084， <0.001）和 OHE 病史（HR=0.15， =0.014）是 CHE 自发缓解的预测因素。
在临床稳定的肝硬化患者中，无需药物干预，CHE 就会加重、持续或自行缓解。根据这些预测因素对患者进行分类，可以更有效地管理 CHE。
