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
Abstract
BACKGROUND

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

AIM

To determine predictors of early readmission and mid-term mortality in cirrhotic patients discharged after the resolution of HE.

METHODS

From January to February 2018, 213 patients were enrolled in this observational study assessing all the successive patients with cirrhosis discharged from Department of Gastroenterology and Department of Infectious and Liver Diseases, Second Affiliated Hospital of Chongqing Medical University after the resolution of HE. The patients were followed for 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. The primary endpoints were incidence of early readmission and mid-term mortality.

RESULTS

During follow-up, 65 (31%) patients experienced an early readmission. International normalized ratio (INR) [odds ratio (OR) = 2.40; P = 0.003) at discharge independently predicted early readmission. The incidence of early readmission was significantly higher in patients with an INR > 1.62 at discharge than in those with an INR ≤ 1.62 (44% vs 19%; P < 0.001). Model for End-stage Liver Disease (MELD) score (OR = 1.11; P = 0.048) at discharge proved to be an independent predictor of early readmission caused by HE. Hemoglobin (OR = 0.97; P = 0.005) at discharge proved to be an independent predictor of non-early readmission. During 6 months of follow-up, 34 (16%) patients died. Artificial liver use (hazard ratio = 6.67; P = 0.021) during the first hospitalization independently predicted mid-term mortality.

CONCLUSION

INR could be applied to identify fragile cirrhotic patients, MELD score could be used to predict early relapse of HE, and anemia is a potential target for preventing early readmission.

Keywords: Cirrhosis, Hepatic encephalopathy, Patient readmission, Mortality, Observational study, Risk factor

Core tip: International normalized ratio at discharge predicts 30-d readmission in cirrhotic patients after the resolution of hepatic encephalopathy (HE) and Model for End-stage Liver Disease score at discharge predicts 30-d readmission caused by HE in these patients. Meantime, hemoglobin level at discharge predicts 30-d non-readmission in these patients.