Hepatic encephalopathy (HE) is a severe complication. We know little about its adverse clinical outcomes in patients with acute-on-chronic liver diseases from the East. 

A recent study published by Long L. et al. investigated the impact of hepatic encephalopathy on clinical characteristics and adverse outcomes in prospective and multicenter cohorts of patients with acute-on-chronic liver diseases by conducting a cohort study of two multicenter prospective cohorts. 

Their study included Acute-on-chronic liver disease patients with various etiologies, which assessed the diagnosis and severity of hepatic encephalopathy using the West Haven scale. The investigators analyzed the correlation between adverse clinical outcomes and varying hepatic encephalopathy grades in the target patients. 

They enrolled 3,949 patients in the study, including 340 patients with hepatic encephalopathy, and found the incidence of HE to be higher in patients with alcohol consumption (9.90%) than in those with hepatitis B virus infection (6.17%). 

They observed that the incidence of 28- and 90-day adverse outcomes increased progressively from hepatic encephalopathy grades 1-4. Further, they found that Hepatic encephalopathy grades 3 and 4 were the independent risk factors for the 28- and 90-day adverse outcome in the fully adjusted model IV. Stratified analyses confirmed these results in the different subgroups. They also observed that Grade 3 hepatic encephalopathy was associated with a significant increase in clinical adverse outcomes than grades 1-2 and patients without hepatic encephalopathy, independent of other organ failures. 

Thus, this study explained Hepatic encephalopathy grades 3-4 as the independent risk factors for 28- and 90-day adverse outcomes. Hence, Hepatic encephalopathy grade 3 could be a potential indicator of brain failure in patients with acute-on-chronic liver disease.

Source: Long  L, Li  H, Deng G, et al. Front Med (Lausanne). 2021 Aug 2;8:709884. doi: 10.3389/fmed.2021.709884.