Published online Sep 14, 2017. doi: 10.3748/wjg.v23.i34.6321
Peer-review started: June 8, 2017
First decision: July 13, 2017
Revised: July 27, 2017
Accepted: August 15, 2017
Article in press: August 15, 2017
Published online: September 14, 2017
Processing time: 99 Days and 23.1 Hours
To explore the natural history of covert hepatic encephalopathy (CHE) in absence of medication intervention.
Consecutive outpatient cirrhotic patients in a Chinese tertiary care hospital were enrolled and evaluated for CHE diagnosis. They were followed up for a mean of 11.2 ± 1.3 mo. Time to the first cirrhosis-related complications requiring hospitalization, including overt HE (OHE), resolution of CHE and death/transplantation, were compared between CHE and no-CHE patients. Predictors for complication(s) and death/transplantation were also analyzed.
A total of 366 patients (age: 47.2 ± 8.6 years, male: 73.0%) were enrolled. CHE was identified in 131 patients (35.8%). CHE patients had higher rates of death and incidence of complications requiring hospitalization, including OHE, compared to unimpaired patients. Moreover, 17.6% of CHE patients developed OHE, 42.0% suffered persistent CHE, and 19.8% of CHE spontaneously resolved. In CHE patients, serum albumin < 30 g/L (HR = 5.22, P = 0.03) was the sole predictor for developing OHE, and blood creatinine > 133 μmol/L (HR = 4.75, P = 0.036) predicted mortality. Child-Pugh B/C (HR = 0.084, P < 0.001) and OHE history (HR = 0.15, P = 0.014) were predictors of spontaneous resolution of CHE.
CHE exacerbates, persists or resolves without medication intervention in clinically stable cirrhosis. Triage of patients based on these predictors will allow for more cost-effect management of CHE.
Core tip: Covert hepatic encephalopathy (CHE) was prevalent in clinically-stable cirrhosis in the tertiary care hospital. A history of overt hepatic encephalopathy (OHE) was the only risk factor for CHE in patients with OHE history, while a high model for end-stage liver disease score was the only risk factor for those without OHE history. Natural history of CHE in the absence of medication intervention included development of complications, persistence or spontaneous resolution of CHE. Triage of patients based on predictors for exacerbation and resolution, rather than the degree of impairment in daily work productivity or quality of life, could make clinical management of CHE more cost-effective.