Published online Jul 14, 2019. doi: 10.3748/wjg.v25.i26.3426
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
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.
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.
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.
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.
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.
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.
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.