Original Article

Cognitive Tests and Stool Frequency at Hospital Discharge Do Not Predict Outcomes in Hepatic Encephalopathy

Authors: Patricia P. Bloom, MD, Samuel J. Miller, MD, Rahul K. Nayak, MD, Muhammad Sarib Hussain, BA, Ashwini Arvind, MBBS, Camden Bay, PhD, Raymond T. Chung, MD


Objectives: Hepatic encephalopathy (HE) is associated with hospital readmissions and mortality. We sought to determine whether cognitive testing and stool frequency at discharge predicted 30-day readmission or death in cirrhotic patients admitted with overt HE.
Methods: We approached consecutive inpatients with cirrhosis and overt HE when they were within 48 hours of discharge. Patients underwent cognitive tests, including Psychometric Hepatic Encephalopathy Score (PHES), and stool frequency was documented. Chart review identified Model for End-Stage Liver Disease-sodium (MELD-Na) and the presence of non-HE extrahepatic organ failures. Cox proportional hazards models were used to evaluate predictors of time to the primary
composite outcome of hospital readmission for HE or death within 30 days, censoring for liver transplantation.
Results: Of 51 patients consented and enrolled, 14 patients met the primary composite outcome. In unadjusted Cox models, 4 variables predicted HE readmission or death: MELD-Na (hazard ratio [HR] 1.10 [1.01–1.20], P = 0.03), respiratory failure (HR 4.26 [1.47–12.35], P = 0.008), total number of HE extrahepatic organ failures (HR 1.79 [1.12–2.88], P = 0.02), and score on a PHES subtest, Number Connection Test A (per 30 seconds; HR 1.25 [1.06–1.47], P = 0.01). PHES and 24-hour stool frequency did not predict the primary outcome. When controlling for MELD-Na, respiratory failure predicted the primary outcome (HR 3.67 [1.24–10.86], P = 0.02).
Conclusion: Cognitive testing and stool frequency at discharge did not predict poor outcomes in patients admitted with HE, while respiratory  failure appeared to be a strong predictor.
Posted in: Gastroenterology25 Liver Disease2

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