Lessons from “real life experience” of rifaximin use in the management of recurrent hepatic encephalopathy

Table 1 Baseline characteristics of study patients (n = 62)

Demographic characteristics
Age, mean ± SD, yr	62 ± 10
Male sex, n (%)	45 (73)
Cirrhosis etiology, n (%)
Alcohol	41 (66)
Alcohol withdrawal, n (%)	34/41 (83)
Hepatitis-B or C virus	16 (26)
Non-alcoholic fatty liver disease	10 (16)
Other	7 (11)
Previous liver related complication, n (%)
HE	62 (100)
Gastrointestinal bleeding	28 (45)
Ascites	39 (63)
Renal failure	24 (39)
Hepatocellular carcinoma	14 (23)
Presence of oesophageal varices	48 (77)
TIPS, n (%)	25 (40)
Scores
Child class, n
A/B/C	2/36/24
Child score, mean ± SD	9.2 ± 2.0
MELD, mean ± SD	16.8 ± 6.4
Total number of HE events occurred in hospitalization or requiring hospitalization, n (%)
0	1 (2)
1	16 (26)
2	17 (27)
> 2	28 (45)
The highest West Haven grade1, n (%)
1	6 (10)
2	20 (32)
3	24 (39)
4	12 (19)
Repeated HE-related hospitalizations (> 1), n (%)	42 (68)
Recurrent HE, n (%)	34 (55)

¹The grade ranges from 0 to 4, with higher scores indicating more severe impairment. HE: Hepatic encephalopathy; TIPS: Transjugular intrahepatic portosystemic shunt; MELD: Model for end-stage liver disease.

Table 2 Predictive factors of response to treatment in the entire cohort (n = 62)

Parameter	Non-responder (n = 26)	Responder (n = 36)	P value
Indication, n (%)
Prevention of recurrent HE episodes/prevention of recurrent acute exacerbations on persistent HE	13 (50)/13 (50)	16 (45)/20 (55)	0.66
Sex (M/F), n (%)	21 (81)/5 (19)	24 (67)/12 (33)	0.22
TIPS, n (%)	8 (31)	17 (47)	0.19
Cirrhosis etiology, n (%)
Alcohol	20 (77)	21 (58)	0.13
Hepatitis-B or C virus	7 (27)	9 (25)	0.86
Lactulose therapy (period 1)
Patients treated, n (%)	22 (85)	31 (86)	1.0
Mean dose, mean ± SD (g)	35 ± 17	39 ± 19	0.48
Age	63 ± 10	62 ± 10	0.89
HE (period 1)
HE events, mean ± SD	1.41 ± 1.0	1.62 ± 1.16	0.23
HE-related hospitalizations, mean ± SD	1.3 ± 1.0	1.40 ± 0.95	0.16
Length of HE-related hospitalization, mean ± SD	14 ± 13	17 ± 16	0.51
Repeated HE-related hospitalizations (> 1), n (%)	16 (62)	26 (72)	0.37
Infectious events	0.31 ± 0.44	0.35 ± 0.47	0.92
Biochemical
INR	1.7 ± 0.8	1.6 ± 0.4	0.71
Serum albumin (g/L)	28 ± 5	29 ± 5	0.63
Serum bilirubin (μmol/L)	63 ± 99	35 ± 20	0.11
Serum sodium (mmol/L)	134 ± 7	135 ± 5	0.62
Serum creatinine (μmol/L)	97 ± 50	107 ± 111	0.65
AST (UI/L)	59 ± 31	80 ± 135	0.45
ALT (UI/L)	33 ± 19	44 ± 30	0.11
Hemoglobin (g/dL)	10.4 ± 1.9	10.5 ± 1.7	0.79
CRP (mg/L)	13 ± 19	11 ± 11	0.67
Scores
Child Pugh score	9 ± 2	9 ± 2	1.0
MELD score	16 ± 6	17 ± 6	0.53

HE: Hepatic encephalopathy; TIPS: Transjugular intrahepatic portosystemic shunt; INR: International normalized ratio; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; CRP: C-reactive protein; MELD: Model for end-stage liver disease.