Abstract
Introduction/Aim
Muscle alterations, portosystemic shunts (SPSS) and minimal hepatic encephalopathy
(MHE) are related to hepatic encephalopathy (HE), however no studies have investigated
the relative role of all these risk factors detected in the same patients. The aim
of the study was to assess the prognostic impact of muscle alterations, MHE and SPSS
on hepatic encephalopathy and transplant free survival.
Patients/Methods
114 cirrhotics were submitted to Psychometric Hepatic Encephalopathy Score (PHES)
and Animal Naming Test (ANT) to detect MHE. CT scan was used to analyze the skeletal
muscle index (SMI), muscle attenuation and SPSS. The incidence of the first episode
of HE and survival were estimated.
Results
Previous HE was present in 47 patients (41%). The variables independently associated
to previous HE were: sarcopenia, MHE and SPSS. 44 patients (39%) developed overt HE
during 14±11 months; MHE and SPSS were the only variables significantly asociated
to overt HE. During the same follow-up, 42 patients died (37%); MELD and sarcopenia
were the only variables significantly asociated to transplant free survival.
Conclusions
MHE, sarcopenia and SPSS are clinically relevant and should be sought for in cirrhotics.
In particular, MHE and SPSS are the only risk factors significantly associated to
the development of HE while MELD and sarcopenia are independently associated to overall
mortality.
Keywords
Abbreviations:
SMI (skeletal muscle index), PHES (Psychometric Hepatic Encephalopathy Score), DST (Digit-Symbol Test), TMT-A (Trail-Making Test A), TMT-B (Trail-Making Test B), SDT (Serial-Dotting Test), LTT (Line-Tracing Test), MHE (minimal hepatic encephalopathy), HE (hepatic encephalopathy), SPSS (spontaneous portosystemic shunts), sHR (subdistribution hazard ratio), BMI (body mass index)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 17, 2022
Accepted:
December 21,
2021
Received:
November 25,
2021
Identification
Copyright
© 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
