Department of Neurology, Hannover Medical School, Hannover.
Department of Gastroenterology, Hepatology and Infectiology, Heinrich Heine University Hospital Düsseldorf, Düsseldorf.
Eur J Gastroenterol Hepatol. 2021 Sep 1;33(9):1185-1193. doi: 10.1097/MEG.0000000000001822.
Patients with hepatic encephalopathy (HE) show low quality of life, recurrent hospitalizations and an increased mortality. We aimed to assess the natural course of patients after a recent episode of overt HE and to identify risk factors for HE recurrence in Germany.
Fifteen sites took part in a prospective, observational study including patients with liver cirrhosis who had been hospitalized for HE within 3 months before recruitment. Clinical data, psychometric hepatic encephalopathy score (PHES) and critical flicker frequency were assessed quarterly for 1 year. Primary endpoint was HE recurrence requiring hospitalization, all-cause-mortality was treated as a competing risk factor.
From January 2014 to March 2016, a total of 115 patients were recruited. Overall 14 premature deaths were documented. For 78 subjects follow-up data were available in accordance with the protocol. After a median of 118 days, more than half of the per-protocol cohort was readmitted to hospital due to HE (N = 34) or died (N = 11). The risk for hospitalization was significantly increased in patients who had been recruited by liver transplant centers (P = 0.003), had had frequent HE relapses prior to recruitment (P = <0.0001) or an abnormal PHES result of <-4 (P = 0.044). Abnormal PHES results barely missed level of significance as an independent risk factor for re-hospitalization in a multivariable competing risk model (P = 0.093).
Patients with a history of HE are at high risk for the development of recurrent overt HE demanding hospitalization. The PHES test may aid in detection, monitoring and risk stratification of recurrent HE.
肝性脑病（HE）患者生活质量较低，反复住院且死亡率较高。本研究旨在评估近期显性 HE 发作后患者的自然病程，并确定德国 HE 复发的危险因素。
15 个研究点参与了一项前瞻性、观察性研究，纳入的患者为在招募前 3 个月内因 HE 住院的肝硬化患者。每季度评估临床数据、心理测量性肝性脑病评分（PHES）和临界闪烁频率，为期 1 年。主要终点为需要住院治疗的 HE 复发，全因死亡率被视为竞争风险因素。
2014 年 1 月至 2016 年 3 月期间，共纳入 115 例患者。共有 14 例患者过早死亡。根据方案，有 78 例患者的随访数据可用。中位随访 118 天后，超过一半的符合方案患者因 HE（N = 34）或死亡（N = 11）再次住院。在被肝移植中心招募的患者（P = 0.003）、在招募前频繁复发 HE（P < 0.0001）或 PHES 结果异常（<-4，P = 0.044）的患者中，住院风险显著增加。PHES 结果异常作为多变量竞争风险模型中再次住院的独立危险因素，其接近显著水平（P = 0.093）。
有 HE 病史的患者发生需要住院治疗的复发性显性 HE 的风险较高。PHES 检测可能有助于检测、监测和对复发性 HE 进行风险分层。
