International normalized ratio and Model for End-stage Liver Disease score predict short-term outcome in cirrhotic patients after the resolution of hepatic encephalopathy

Table 1 Characteristics of whole population and comparison between patients readmitted early or not

Variable	Whole population	Readmitted	Non-readmitted	P-value
	(n = 213)	(n = 65)	(n = 148)
Age (yr), mean (SD)	57 (11)	56 (11)	57 (10)	0.536
Gender (male)	153 (72)	44 (68)	109 (74)	0.374
Etiology, n (%)				0.946
HBV	116 (54)	37 (57)	79 (53)
HCV	13 (6)	4 (6)	9 (6)
Alcohol	34 (16)	9 (14)	25 (17)
Other	50 (23)	15 (23)	35 (24)
Comorbidity, n (%)	68 (32)	15 (23)	53 (36)	0.066
Diabetes, n (%)	52 (24)	12 (18)	40 (27)	0.180
Chronic kidney disease, n (%)	6 (3)	1 (2)	5 (3)	0.455
Hypertension, n (%)	24 (11)	5 (8)	19 (13)	0.274
Charlson comorbidity score, mean (SD)	3.6 (1.2)	3.6 (1.3)	3.6 (1.2)	0.936
Albumin (g/L), mean (SD)1	30 (4)	30 (3)	30 (4)	0.454
Total bilirubin (μmol/L), mean (SD)1	48 (58)	57 (75)	44 (48)	0.214
WBC (×109/L), mean (SD)1	3.8 (2.0)	3.9 (1.8)	3.8 (2.1)	0.895
Serum sodium (mmol/L), mean (SD)1	139.0 (4.6)	138.0 (3.5)	139.0 (5.0)	0.576
Serum potassium (mmol/L), mean (SD)1	3.9 (0.5)	3.9 (0.5)	3.9 (0.5)	0.786
SCr (μmol/L), mean (SD)1	85 (95)	95 (157)	80 (45)	0.441
PTA (%), mean (SD)1	52 (17)	47 (17)	55 (16)	0.001
INR, mean (SD)1	1.7 (0.5)	1.9 (0.6)	1.6 (0.5)	0.001
Hb (g/L), mean (SD)1	92 (20)	85 (15)	95 (21)	0.001
PLT (×109/L), mean (SD)1	87 (68)	94 (71)	84 (67)	0.350
Ascites, n (%)1	21 (10)	11 (17)	10 (7)	0.022
HRS during hospital stay, n (%)1	4 (2)	2 (3)	2 (1)	0.393
AKI during hospital stay, n (%)1	1 (0.5)	0 (0)	1 (0.7)	0.507
ACLF during hospital stay, n (%)1	9 (4)	2 (3)	7 (5)	0.581
MELD score, mean (SD)1	12.9 (5.8)	12.7 (5.2)	13.0 (6.0)	0.719
Length of hospital stay (d), mean (SD)1	16 (13)	15 (13)	16 (13)	0.646
Artificial liver use, n (%)1	4 (2)	2 (3)	2 (1)	0.393
Anti-HE treatment course (d), mean (SD)1	11 (8)	12 (9)	10 (7)	0.159
Preventing HE with medications post discharge, n (%)	130 (61)	40 (62)	90 (61)	0.920
Progression to HCC, n (%)	27 (13)	8 (12)	19 (13)	0.915

¹ Variables collected at discharge. ACLF: Acute-on-chronic liver failure; AKI: Acute kidney injury; HBV: Hepatitis B virus; HCV: Hepatitis C virus; Hb: Hemoglobin; HRS: Hepatorenal syndrome; HE: Hepatic encephalopathy; HCC: Hepatocellular carcinoma; INR: International normalized ratio; MELD: Model for End-stage Liver Disease; PTA: Prothrombin activity; PLT: Platelets; SCr: Serum creatinine; WBC: White blood cells.

Table 2 Characteristics of hepatic encephalopathy in whole population and comparison between patients readmitted early or not, n (%)

Variable	Whole population	Readmitted	Non-readmitted	P-value
	(n = 213)	(n = 65)	(n = 148)
Incentives of HE				0.645
No obvious incentive	114 (54)	35 (54)	79 (53)
High protein diet	47 (22)	12 (18)	35 (24)
Infection	16 (8)	6 (9)	10 (7)
GI bleeding	15 (7)	7 (11)	8 (5)
Electrolyte disturbances	3 (1)	1 (2)	2 (1)
Other	18 (8)	4 (6)	14 (9)
Degree of HE				0.341
I	139 (65)	39 (60)	100 (68)
II	49 (23)	15 (23)	34 (23)
III	21 (10)	10 (15)	11 (7)
IV	4 (2.0)	1 (2.0)	3 (2.0)
Treatment for HE				0.523
L + AO	139 (65)	48 (74)	91 (62)
L + R + AO	1 (0.5)	0 (0)	1 (0.7)
L	2 (0.9)	1 (1.5)	1 (0.7)
WVE + AO	1 (0.5)	0 (0)	1 (0.7)
AO	61 (29)	15 (23)	46 (31)
Nothing	3 (1.4)	0 (0)	3 (2.0)
L + AO + WVE	6 (2.8)	1 (1.5)	5 (3.4)

AO: Aspartate ornithine; GI: Gastrointestinal; HE: Hepatic encephalopathy; L: Lactulose; R: Rifaximin; WVE: White vinegar enema.

Table 3 Multivariate analysis of readmission at 30 d

Variable	OR	95%CI	P-value
Hb at discharge	0.97	0.96-0.99	0.005
INR at discharge	2.40	1.36-4.26	0.003
MELD score1	1.11	1.00-1.24	0.048

¹When hepatic encephalopathy was considered the only cause of readmission. CI: Confidence interval; Hb: Hemoglobin; INR: International normalized ratio; MELD: Model for End-stage Liver Disease; OR: Odds ratio.

Table 4 Characteristics of survivors and non-survivors at 6 mo¹

Variable	Survivors	Non-survivors	P-value
	(n = 179)	(n = 34)
Age (yr), mean (SD)	57 (11)	57 (11)	0.927
Gender (male), n (%)	130 (73)	23 (68)	0.554
Etiology, n (%)			0.743
HBV	95 (53)	21 (62)
HCV	12 (7)	1 (3)
Alcohol	29 (16)	5 (15)
Other	43 (24)	7 (21)
Comorbidity, n (%)	61 (34)	7 (21)	0.122
Diabetes, n (%)	46 (26)	6 (18)	0.316
Chronic kidney disease, n (%)	4 (21)	2 (6)	0.239
Hypertension, n (%)	21 (12)	3 (9)	0.623
Charlson comorbidity score, mean (SD)	3.6 (1.2)	3.8 (1.3)	0.286
Albumin (g/L), mean (SD)2	30 (4)	30 (4)	0.204
Total bilirubin (μmol/L), mean (SD)2	42 (44)	76 (100)	0.061
WBC (×109/L), mean (SD)2	3.8 (1.9)	4.0 (2.5)	0.546
Serum sodium (mmol/L), mean (SD)2	139 (5)	137 (3)	0.017
Serum potassium (mmol/L), mean (SD)2	3.9 (0.5)	3.9 (0.5)	0.677
SCr (μmol/L), mean (SD)2	82 (97)	98 (79)	0.390
PTA (%), mean (SD)2	53 (16)	47 (19)	0.068
INR, mean (SD)2	1.7 (0.4)	2.0 (0.8)	0.012
Hb (g/L), mean (SD)2	94 (20)	84 (18)	0.007
PLT (×109/L), mean (SD)2	87 (67)	88 (73)	0.937
Ascites, n (%)2	16 (9)	5 (15)	0.301
HRS during hospital stay, n (%)2	2 (1)	2 (6)	0.061
AKI during hospital stay, n (%)2	0 (0)	1 (3)	0.021
ACLF during hospital stay, n (%)2	7 (4)	2 (6)	0.600
MELD score, mean (SD)2	13 (6)	12 (6)	0.006
Length of hospital stay (d), mean (SD)2	15.8 (13.0)	17.0 (12.5)	0.621
Artificial liver use, n (%)2	2 (1)	2 (6)	0.061
Anti-HE treatment course (d), mean (SD)2	11 (8)	10 (6)	0.646
Preventing HE with medications post discharge, n (%)	112 (63)	18 (53)	0.291
Progression to HCC, n (%)	18 (10)	9 (26)	0.008
Early readmission, n (%)	47 (26)	18 (53)	0.002

¹ Patients lost to follow-up or transplanted were excluded from this analysis;

² Variables collected at discharge. ACLF: Acute-on-chronic liver failure; AKI: Acute kidney injury; HBV: Hepatitis B virus; HCV: Hepatitis C virus; Hb: Hemoglobin; HRS: Hepatorenal syndrome; HE: Hepatic encephalopathy; HCC: Hepatocellular carcinoma; INR: International normalized ratio; MELD: Model for End-stage Liver Disease; PTA: Prothrombin activity; PLT: Platelets; SCr: Serum creatinine; WBC: White blood cells.

Table 5 Characteristics of hepatic encephalopathy between survivors and non-survivors at 6 mo n (%)

Variable	Survivors	Non-survivors	P-value
	(n = 179)	(n = 34)
Incentive of HE			0.689
No obvious incentive	92 (51)	22 (65)
High protein diet	40 (22)	7 (21)
Infection	15 (8)	1 (3)
GI bleeding	13 (7)	2 (6)
Electrolyte disturbances	3 (2)	0 (0)
Other	16 (9)	2 (6)
Degree of HE			0.935
I	116 (65)	23 (68)
II	42 (23)	7 (21)
III	18 (10)	3 (9)
IV	3 (1.6)	1 (2.9)
Treatment for HE			0.329
L + AO	116 (65)	23 (68)
L + R + AO	1 (0.6)	0 (0)
L	2 (1.1)	0 (0)
WVE + AO	1 (0.6)	0 (0)
AO	53 (30)	8 (23)
Nothing	1 (0.6)	2 (5.9)
L + AO + WVE	5 (2.8)	1 (2.9)

AO: Aspartate ornithine; GI: Gastrointestinal; HE: Hepatic encephalopathy; L: Lactulose; R: Rifaximin; WVE: White vinegar enema.

Table 6 Multivariate analysis of mortality at 6 mo

Variable	HR	95%CI	P-value
Artificial liver use	6.67	1.33-33.49	0.021

CI: Confidence interval; HR: Hazard ratio.