%A Long,Liyuan %A Li,Hai %A Deng,Guohong %A Wang,Xianbo %A Lu,Sihong %A Li,Beiling %A Meng,Zhongji %A Gao,Yanhang %A Qian,Zhiping %A Liu,Feng %A Lu,Xiaobo %A Ren,Haotang %A Shang,Jia %A Li,Hai %A Wang,Shaoyang %A Zheng,Yubao %A Yan,Huadong %A Yin,Shan %A Tan,Wenting %A Zhang,Qun %A Zheng,Xin %A Chen,Jinjun %A Luo,Sen %A Zhao,Jinming %A Yuan,Wei %A Li,Tao %A Zheng,Rongjiong %A Liu,Junping %A Liu,Xiaoxiao %A Gu,Wenyi %A Li,Sumeng %A Mei,Xue %A Chen,Ruochan %A Huang,Yan %D 2021 %J Frontiers in Medicine %C %F %G English %K Hepatic Encephalopathy,Brain failure,acute on chronic liver disease,Prospective,multicenter %Q %R 10.3389/fmed.2021.709884 %W %L %M %P %7 %8 2021-August-02 %9 Original Research %# %! Impact of HE with AoCLD %* %< %T Impact of Hepatic Encephalopathy on Clinical Characteristics and Adverse Outcomes in Prospective and Multicenter Cohorts of Patients With Acute-on-Chronic Liver Diseases %U https://www.frontiersin.org/articles/10.3389/fmed.2021.709884 %V 8 %0 JOURNAL ARTICLE %@ 2296-858X %X Importance: Hepatic encephalopathy is a severe complication, and its contribution to clinical adverse outcomes in patients with acute-on-chronic liver diseases from the East is unclear.Objective: We aimed to investigate the impact of hepatic encephalopathy on clinical characteristics and adverse outcomes in prospective and multicenter cohorts of patients with acute-on-chronic liver diseases.Design: We conducted a cohort study of two multicenter prospective cohorts.Setting: China.Participants: Acute-on-chronic liver disease patients with various etiologies.Exposure: The diagnosis and severity of hepatic encephalopathy were assessed using the West Haven scale.Main Outcome Measure: The correlation between clinical adverse outcomes and varying hepatic encephalopathy grades was analyzed in the target patients.Results: A total of 3,949 patients were included, and 340 of them had hepatic encephalopathy. The incidence of hepatic encephalopathy was higher in patients with alcohol consumption (9.90%) than in those with hepatitis B virus infection (6.17%). The incidence of 28- and 90-day adverse outcomes increased progressively from hepatic encephalopathy grades 1–4. Logistic regression analysis revealed that hepatic encephalopathy grades 3 and 4 were independent risk factors for the 28- and 90-day adverse outcome in the fully adjusted model IV. Stratified analyses showed similar results in the different subgroups. Compared to grades 1–2 and patients without hepatic encephalopathy, those with grade 3 hepatic encephalopathy had a significant increase in clinical adverse outcomes, independent of other organ failures.Conclusions and Relevance: Hepatic encephalopathy grades 3–4 were independent risk factors for 28- and 90-day adverse outcomes. Hepatic encephalopathy grade 3 could be used as an indicator of brain failure in patients with acute-on-chronic liver disease.