ArticleUnited European gastroenterology journal2025
Multiple Concomitant Precipitating Factors of Hepatic Encephalopathy Are Associated With a Poor Prognosis in Patients With Cirrhosis Admitted to Intensive Care Unit.
Article in United European gastroenterology journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Review article: Immunosuppression in Decompensated Autoimmune Hepatitis Cirrhosis - To Suppress or Not to Suppress?Alimentary pharmacology & therapeutics · 2026Review
- Reducing the Risk of Overt Hepatic Encephalopathy Recurrence: A Narrative Review.Journal of clinical and translational hepatology · 2026Review
- Beyond the Tipping Point: Advances in the Diagnosis and Management of Acute-on-Chronic Liver Failure and End-Stage Liver Disease.Diagnostics (Basel, Switzerland) · 2026Review
- Alterations in Oral Cecal Transit Time and Small Intestinal Microbiota in Minimal Hepatic Encephalopathy With Small Intestinal Bacterial Overgrowth.Clinical and translational gastroenterology · 2026Article
- Clinical prediction of the mortality for acute kidney injury in decompensated cirrhosis.Scientific reports · 2026Article
- Plasma Ammonia Levels Over the Course of a Hospitalisation for Overt Hepatic Encephalopathy.Liver international : official journal of the International Association for the Study of the Liver · 2025Article
- Sociodemographic disparities in documented nonadherence to medication for hepatic encephalopathy: a National Inpatient Sample analysis.Annals of gastroenterologyArticle
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8 authors.
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Abstract
introductionManagement of hepatic encephalopathy relies on the identification and control of precipitating factors (PF). The prognostic value of a PF is unknown, which we aimed to explore. PATIENTS AND
methodsSingle-center retrospective study of cirrhotic patients included in a prospective cohort admitted to an intensive care unit (ICU) between 2019 and 2022. INCLUSION CRITERIA: cirrhosis; overt hepatic encephalopathy; ammonemia ≥ 50 μmol/L. PF considered: gastrointestinal bleeding, infection, acute renal injury (AKI), hyponatremia, constipation, non-adherence to ammonia-lowering therapy, TIPS, drugs precipitating overt hepatic encephalopathy. The primary endpoint was 1-year transplant-free survival (TFS). Secondary endpoint was recurrence of hepatic encephalopathy.
results179/497 patients were included (men 72%, age 59, cause of cirrhosis alcohol (ALD)/metALD/MASLD/other in 41/21/6/32%, Child-Pugh A/B/C in 1/18/81%, West Haven grade 2/3/4 in 63/15/22%, MELD score 23). Reasons for admission were: gastrointestinal bleeding (31%), acute encephalopathy (28%), worsening liver function/jaundice (25%), infection (8%), and AKI (8%). All patients (100%) had at least one PF of hepatic encephalopathy (infection [64%], AKI [63%], drugs [41%], bleeding [36%], hyponatremia [22%], TIPS [12%], and constipation [1%]), and 82% had multiple concomitant PF. In-hospital mortality was 50%, and median TFS was 0.8 months. In multivariate analysis, factors associated with death or liver transplantation were the number of PF, MELD and Child-Pugh scores, ACLF, AKI and infection. Hepatic encephalopathy reoccurred in 42% (median delay of 30 months).
conclusionAll patients had precipitating factor of hepatic encephalopathy, 82% of them having multiple concomitant precipitating factors. Concomitant multiple precipitating factors were associated with death or liver transplantation. A systematic screening for all precipitating factors of hepatic encephalopathy should be proposed for cirrhotics admitted to intensive care unit.
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