AUTHOR=Long Liyuan , Li Hai , Deng Guohong , Wang Xianbo , Lu Sihong , Li Beiling , Meng Zhongji , Gao Yanhang , Qian Zhiping , Liu Feng , Lu Xiaobo , Ren Haotang , Shang Jia , Li Hai , Wang Shaoyang , Zheng Yubao , Yan Huadong , Yin Shan , Tan Wenting , Zhang Qun , Zheng Xin , Chen Jinjun , Luo Sen , Zhao Jinming , Yuan Wei , Li Tao , Zheng Rongjiong , Liu Junping , Liu Xiaoxiao , Gu Wenyi , Li Sumeng , Mei Xue , Chen Ruochan , Huang Yan 

TITLE=Impact of Hepatic Encephalopathy on Clinical Characteristics and Adverse Outcomes in Prospective and Multicenter Cohorts of Patients With Acute-on-Chronic Liver Diseases

JOURNAL=Frontiers in Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.709884

DOI=10.3389/fmed.2021.709884

ISSN=2296-858X

ABSTRACT=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 3949 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-day and 90-day adverse outcomes increased progressively from hepatic encephalopathy grades 1 to 4. Logistic regression analysis revealed that hepatic encephalopathy grades 3 and 4 were independent risk factors for the 28-day 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-day 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.