Efficacy of long-term rifaximin treatment for hepatic encephalopathy in the Japanese

doi:10.4254/wjh.v11.i6.531

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World Journal of Hepatology

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1948-5182

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Hepatol. Jun 27, 2019; 11(6): 531-541
Published online Jun 27, 2019. doi: 10.4254/wjh.v11.i6.531

Table 1 Patient baseline characteristics

	Rifaximin (n = 38)	Control (n = 38)	P value
Age (yr)	69 (40-85)	69.5 (42-90)	0.934
Sex (female/male)	17 (44.7%)/21 (55.3%)	11 (28.9%)/27 (71.1%)	0.234
BMI (kg/m²)	24.78(18.67-35.88)	23.1 (15.5-30.1)	0.035
Etiology (HBV/HCV/Alcohol/NASH)	7 (18.4%)/5 (13.2%)/13 (34.2%)/5 (13.2%)	4 (10.5%)/14 (36.8%)/9 (23.7%)/3 (7.9%)	0.107
Child-Pugh A/B/C	15 (39.5%)/15 (39.5%)/8 (21.1%)	20 (52.6%)/ 17 (44.7%)/1 (2.6%)	0.051
ALBI Grade	1(2.6%) /27 (71.1%) /10 (26.3%)	22 (57.9%)/15 (39.5%)/1(2.6%)	< 0.001
MELD Score¹	6 (2-17)	9 (0-22)	0.205
ALT (IU/L)¹	24.5 (8.0-105.0)	31.5 (8.0-1490)	0.109
AST (IU/L)¹	39.5 (20.0-136.0)	45 (15-1041)	0.426
GGTP (IU/L)¹	35.5 (11.0-558.0)	64 (14-506)	0.055
Serum ammonia	104 (59-297)	52 (23-89)	< 0.001
Albumin (g/dL)¹	3.0 (2.1-4.4)	4.05 (2.4-5.0)	< 0.001
Total bilirubin (mg/dL)¹	1.65 (0.4-4.7)	1.0 (0.4-8.6)	0.002
Platelet count (×103/μL)¹	8.7 (4.8-27.9)	12.3 (2.3-30.2)	0.023
Prothrombin activity (%)	60 (38-133)	69 (14-108)	0.066
AFP (ng/mL)¹	4.3 (1.0-3375)	6.25 (1.3-385.5)	0.065
DCP (mAU/mL)¹	37 (15-3178)	25 (11-11688)	0.383
Fibrosis 4 index¹	5.61 (1.71-15.1)	4.25 (1.2-33.4)	0.117
MRE (kPa)¹	5.04 (3.00-11.11)	4.86 (3.36-12.50)	0.748
SWE (kPa)¹	23.1 (8.3-56)	16.8 (7.0-36.8)	< 0.001
History of overt hepatic encephalopathy	12 (31.6%)	0 (0%)	< 0.001
HCC	9 (23.7%)	12 (31.6%)	0.442
Ascites	11 (29.0%)	10 (26.3%)	0.834
Esophageal varices	27 (71.1%)	23 (60.5%)	0.469
Max diameter of portosystemic shunts (mm)	7.6 (1.7-18.5)	4.2 (1.6-10.9)	< 0.001
Number of portosystemic shunts (0,1/2-)	8 (22.2%)/28 (77.8%)	24 (63.2%)/14 (36.8%)	0.001
Lactulose	29 (76.3%)	6 (15.8%)	< 0.001
BCAA	24 (63.2%)	14 (36.8%)	0.038
Sarcopenia	17 (44.7%)	17 (44.7%)	1
Follow up period (wk)¹	61 (24-91)	91 (5-120)	< 0.001

¹Values are expressed as median (range). BMI: Body mass index; HBV: Hepatitis B virus; HCV: Hepatitis C virus; NASH: Non-alcoholic steatohepatitis; ALBI score: Albumin bilirubin score; MELD score: Model for End-Stage Liver Disease score; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGTP: Gamma-glutamyl transpeptidase; AFP: Alpha fetoprotein; DCP: Des-gamma carboxyprothrombin; MRE: Magnetic resonance elastography; SWE: Shear wave elastography; HCC: Hepatocellular carcinoma; BCAA: Branched-chain amino acid.

Table 2 Risk factors for insufficient improvement of serum ammonia after rifaximin treatment

Category	HR (95%CI)	P value
Category	HR (95%CI)	P value
Univariate analysis
Age (yr at MRE)
< 70	1
≥ 70	2.2 (0.56-8.7)	0.26
Sex
female	1
male	0.491 (0.128-1.88)	0.30
BMI (kg/m²)
< 28	1
≥ 28	0.42 (0.094-1.85)	0.25
AST (IU/L)
< 36	1
≥ 36	0.372 (0.094-1.47)	0.16
ALT (IU/L)
< 30	1
≥ 30	0.43 (0.11-1.7)	0.23
GGTP (IU/L)^a
< 42	1
≥ 42	0.71 (0.18-2.87)	0.64
Albumin (g/dL)
≥ 3.0	1
< 3.0	3.3 (0.83-13)	0.091
Total bilirubin (mg/dL)
< 1.4	1
≥ 1.4	3.0 (0.76-12)	0.12
Platelet count (×10³/μL)
≥ 6.8	1
< 6.8	4.1 (0.67-25)	0.13
Prothrombin activity (%)
< 58	1	0.13
≥ 58	3.0 (0.72-13)
AFP (ng/mL)
< 6.5	1
≥ 6.5	3.25 (0.55-19)	0.20
DCP (mAU/mL)
< 18	1
≥ 18	3.6 (0.57-23)	0.17
Ascites
Absent	1	0.16
Present	2.5 (0.70-8.8)
Esophageal varices
Absent	1	0.42
Present	1.8 (0.43-7.5)
History of hepatic encephalopathy
Absent	1	0.11
Present	3.6 (0.77-16)
HCC¹
Absent	1	0.72
Present	0.75 (0.16-3.6)
Sarcopenia
Absent	1	0.49
Present	1.64 (0.41-6.6)
Child-Pugh Score		0.061
< 7	1
≥ 7	3.9 (0.94-16)
ALBI Score
< -1.6	1
≥ -1.6	5.3 (1.1-25)	0.033
MELD Score
< 12	1	0.13
≥ 12	3.0 (0.72-13)
Fibrosis 4 index
< 8.3	1
≥ 8.3	0.42 (0.094-1.9)	0.25
MRE (kPa)
< 5.0	1	0.43
≥ 5.0	1.63 (0.40-8.3)
SWE (kPa)
< 17.7	1
≥ 17.7	3.0 (0.65-14)	0.16
Max diameter of portosystemic shunt
< 8.0	1
≥ 8.0	6.8 (1.4-33)	0.017
Number of portosystemic shunt systems
0,1	1	0.68
2-4	1.36 (0.32-5.9)
Multivariate analysis
Max diameter of portosystemic shunt
< 8.0	1
≥ 8.0	5.5 (1.1-28)	0.039
ALBI Score		0.16
< -1.6	1
≥ -1.6	3.3 (0.62-18)

BMI: Body mass index; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGTP: Gamma-glutamyl transpeptidase; AFP: Alpha fetoprotein; DCP: Des-gamma carboxyprothrombin; HCC: Hepatocellular carcinoma; MELD Score: Model for End-Stage Liver Disease score; ALBI Score: Albumin-bilirubin score; MRE: Magnetic resonance elastography; SWE: Shear wave elastography.

Citation: Nishida S, Hamada K, Nishino N, Fukushima D, Koyanagi R, Horikawa Y, Shiwa Y, Saitoh S. Efficacy of long-term rifaximin treatment for hepatic encephalopathy in the Japanese. World J Hepatol 2019; 11(6): 531-541
URL: https://www.wjgnet.com/1948-5182/full/v11/i6/531.htm
DOI: https://dx.doi.org/10.4254/wjh.v11.i6.531