ArticleClinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association2023
Admission Serum Metabolites and Thyroxine Predict Advanced Hepatic Encephalopathy in a Multicenter Inpatient Cirrhosis Cohort.
Article in Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 25 citations in OpenAlex.
- Risk prediction models for hepatic encephalopathy in patients with liver cirrhosis: a systematic review and meta-analysis.BMC gastroenterology · 2026Pooled it
- Substitution of One Meat-Based Meal With Vegetarian and Vegan Alternatives Generates Lower Ammonia and Alters Metabolites in Cirrhosis: A Randomized Clinical Trial.Clinical and translational gastroenterology · 2024Trial
- Plasma Metabolites for Identifying Bacterial Infection in Acute-on-chronic Liver Failure: A Prospective Multicenter Study.Journal of clinical and translational hepatology · 2026Article
- A global consensus on the critical care management of acute-on-chronic liver failure patients: the APASL ACLF Beijing Position Paper.Hepatology international · 2026Article
- The multi-omic basis for hepatic encephalopathy recurrence: Analysis of the THEMATIC trial.JHEP reports : innovation in hepatology · 2026Article
- Transparent and dynamic network-based risk assessment for development of hepatic encephalopathy.Communications medicine · 2025Article
- Applying Metabolomics and Aptamer-Based Proteomics to Determine Pathophysiologic Differences in Decompensated Cirrhosis Patients Hospitalized with Acute Kidney Injury.Digestive diseases and sciences · 2025Article
- Machine learning techniques in hepatic encephalopathy: a scoping review.BMC medical informatics and decision making · 2025Article
- Fecal carriage of multidrug-resistant organisms increases the risk of hepatic encephalopathy in patients with cirrhosis: insights from gut microbiota and metabolite features.Gut pathogens · 2025Article
- Hepatic-associated vascular morphological assessment to predict overt hepatic encephalopathy before TIPS: a multicenter study.Hepatology international · 2024Article
- Dissecting causal relationships between gut microbiota, blood metabolites, and glioblastoma multiforme: a two-sample Mendelian randomization study.Frontiers in microbiology · 2024Article
- Thyroxine Levels Predict the Development of Brain Failure in Patients With Cirrhosis in Indian Population.Gastro hep advances · 2024Review
- The Free Triiodothyronine, Gamma-Glutamyl Transpeptidase and Spontaneous Bacterial Peritonitis Index: A Novel Model for Predicting 1-Year Mortality in Patients with HBV-Related Hepatic Encephalopathy.Hepatic medicine : evidence and research · 2024Article
- Article
- Evolution of non-thyroidal illness syndrome in acute decompensation of liver cirrhosis and acute-on-chronic liver failure.Frontiers in endocrinology · 2023Article
- Decompensated Hypothyroidism in a Patient With Cirrhosis: A Rare Presentation of Severe Hypothyroidism With Hypertension.AACE endocrinology and diabetesArticle
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Authors and funding
14 authors at 10 institutions in 2 countries.
Funding
Abstract
BACKGROUND &
aimsGrades 3 to 4 hepatic encephalopathy (advanced HE), also termed brain failure, is an organ failure that defines acute-on-chronic liver failure. It is associated with poor outcomes in cirrhosis but cannot be predicted accurately. We aimed to determine the admission metabolomic biomarkers able to predict the development of advanced HE with subsequent validation.
methodsProspective inpatient cirrhosis cohorts (multicenter and 2-center validation) without brain failure underwent admission serum collection and inpatient follow-up evaluation. Serum metabolomics were analyzed to predict brain failure on random forest analysis and logistic regression. A separate validation cohort also was recruited.
resultsThe multicenter cohort included 602 patients, of whom 144 developed brain failure (105 only brain failure) 3 days after admission. Unadjusted random forest analysis showed that higher admission microbially derived metabolites and lower isoleucine, thyroxine, and lysophospholipids were associated with brain failure development (area under the curve, 0.87 all; 0.90 brain failure only). Logistic regression area under the curve with only clinical variables significantly improved with metabolites (95% CI 0.65-0.75; P = .005). Four metabolites that significantly added to brain failure prediction were low thyroxine and maltose and high methyl-4-hydroxybenzoate sulfate and 3-4 dihydroxy butyrate. Thyroxine alone also significantly added to the model (P = .05). The validation cohort including 81 prospectively enrolled patients, of whom 11 developed brain failure. Admission hospital laboratory thyroxine levels predicted brain failure development despite controlling for clinical variables with high specificity.
conclusionsIn a multicenter inpatient cohort, admission serum metabolites, including thyroxine, predicted advanced HE development independent of clinical factors. Admission low local laboratory thyroxine levels were validated as a predictor of advanced HE development in a separate cohort.
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