Liver, Pancreas and Biliary Tract| Volume 54, ISSUE 8, P1060-1065, August 2022

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Risk factors for hepatic encephalopathy and mortality in cirrhosis: The role of cognitive impairment, muscle alterations and shunts

Published:January 17, 2022DOI:



      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.


      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.


      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.


      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.



      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)
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