Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2019; 25(26): 3426-3437
Published online Jul 14, 2019. doi: 10.3748/wjg.v25.i26.3426
International normalized ratio and Model for End-stage Liver Disease score predict short-term outcome in cirrhotic patients after the resolution of hepatic encephalopathy
Xiao-Peng Hu, Jian Gao
Xiao-Peng Hu, Second Clinical College, Chongqing Medical University, Chongqing 400010, China
Jian Gao, Department of Gastroenterology, Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
Author contributions: Hu XP designed the study, collected, analysed, and interpreted the data, and drafted the manuscript; Gao J designed the study, supervised the study, and critically reviewed the study; both authors have approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the ethics committee of the Second Affiliated Hospital of Chongqing Medical University (No. 2017-064).
Informed consent statement: All study participants provided written informed consent prior to study enrollment.
Conflict-of-interest statement: None declared.
Data sharing statement: No additional data are available.
STROBE statement: The guidelines of the STROBE Statement have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jian Gao, PhD, Professor, Chief Doctor, Department of Gastroenterology, Second Affiliated Hospital, Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing 400010, China. 982213482@qq.com
Telephone: +86-23-63693325 Fax: +86-23-63693323
Received: April 8, 2019
Peer-review started: April 8, 2019
First decision: April 30, 2019
Revised: May 7, 2019
Accepted: June 8, 2019
Article in press: June 8, 2019
Published online: July 14, 2019
ARTICLE HIGHLIGHTS
Research Background

Among cirrhotic patients, hepatic encephalopathy (HE) indicates a poor prognosis despite the use of artificial liver and liver transplantation, presenting as frequent hospitalizations and increased mortality rate.

Research motivation

The aim of this study was to determine predictors of early readmission and mid-term mortality in patients with cirrhosis after an episode of HE, which may contribute to early recognition of fragile cirrhotic patients.

Research objectives

To determine predictors of early readmission and mid-term mortality in patients with cirrhosis after an episode of HE to provide theoretical support for the management of cirrhotic patients.

Research methods

This is an observational study, and the total follow-up time was 6 mo. The primary endpoints were the incidence of early readmission (30 d) and mid-term mortality (6 mo). For each subject, demographic, clinical, and laboratory variables were assessed at the time of diagnosis of HE, during hospital stay, at discharge, and during follow-up.

Research results

International normalized ratio (INR) level at discharge predicted early readmission in cirrhotic patients after the resolution of HE and Model for End-stage Liver Disease score at discharge predicted early readmission caused by HE in these patients. Meanwhile, hemoglobin level at discharge predicted early non-readmission in these patients. Finally, artificial liver use during the first hospitalization independently predicted mid-term mortality.

Research conclusions

INR could be applied to identify fragile cirrhotic patients, Model for End-stage Liver Disease score could be used to predict early relapse of HE, and anemia is a potential target for preventing early readmission.

Research perspectives

Further controlled trials are needed to verify the efficacy of these strategies in lowering early readmission rate when surveilling fragile cirrhotic patients. Expect for patients with anemia, how those patients with an elevated INR and MELD score can be prevented from readmission remains a question that needs to be answered in future studies.