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Gabriel, Maria M.; Kircheis, Gerald; Hardtke, Svenja; Markwardt, Daniel; Buggisch, Peter; Mix, Heiko; Gruengreiff, Kurt; Welzel, Tanja M.; Kaelsch, Julia; Hartmann, Heinz; Gerbes, Alexander L.; Karpowitz, Maria V.; Seeliger, Benjamin; Wedemeyer, Heiner und Weissenborn, Karin (2021): Risk of recurrent hepatic encephalopathy in patients with liver cirrhosis: a German registry study. In: European Journal of Gastroenterology & Hepatology, Bd. 33, Nr. 9: S. 1185-1193

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Abstract

Background and aims 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. Methods 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. Results 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). Conclusion 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.

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