E. Román

Minimal Hepatic Encephalopathy Is Associated With Falls

OBJECTIVES:Minimal hepatic encephalopathy (MHE) reduces quality of life and impacts daily functioning. It is known to impair fitness to drive, but deficits in attention and reaction may also be associated with falls. Falls may have important consequences in patients with cirrhosis due to coagulopathy, osteoporosis, and operative risk. However, the relationship between MHE and falls has not yet been evaluated. The objective of this study is to retrospectively investigate whether MHE is associated with falls in patients with cirrhosis.METHODS:We included 130 cirrhotic outpatients and 43 controls. MHE was diagnosed according to the results of the psychometric hepatic encephalopathy score (PHES). We recorded the reported incidence and number of falls in the 12 months before the study, the severity of injuries, and the need for healthcare services.RESULTS:Forty-five (34.6%) patients with cirrhosis exhibited MHE. The proportion of patients with MHE that reported falls (40%) was higher than those without MHE (12.9%, P<0.001), which was similar to controls (11.6%). In patients with MHE, there was a higher need for primary healthcare services (8.8 vs. 0%, P=0.004) and hospitalization (6.6 vs. 2.3%, P=0.34) due to falls than in patients without MHE. Patients on psychoactive drugs (n=21) showed a stronger association between MHE and falls: 6/8 (75%) patients with MHE presented falls vs. 2/13 (15.3%) patients without MHE (P=0.01). In patients not receiving psychoactive drugs (n=109), the incidence of falls was 12/37 (32.4%) in patients with MHE vs. 9/72 (12.5%) in those without MHE (P=0.01). Multivariate analysis showed that MHE (odds ratio (OR): 2.91, 95% confidence interval (CI): 1.13–7.48, P=0.02), previous encephalopathy (OR: 2.87, 95% CI: 1.10–7.50, P=0.03), and antidepressant therapy (OR: 3.91, 95% CI: 0.96–15.9, P=0.05) were independent factors associated to previous falls.CONCLUSIONS:Falls are more frequent in cirrhotic patients with MHE, particularly in those on treatment with psychoactive drugs, and are a significant cause for healthcare and hospitalization requirements.

Effects of intravenous albumin in patients with cirrhosis and episodic hepatic encephalopathy: A randomized double-blind study

BACKGROUND & AIMSnEpisodic hepatic encephalopathy is frequently precipitated by factors that induce circulatory dysfunction, cause oxidative stress-mediated damage or enhance astrocyte swelling. The administration of albumin could modify these factors and improve the outcome of hepatic encephalopathy. The aim of this study is to assess the efficacy of albumin in a multicenter, prospective, double-blind, controlled trial (ClinicalTrials.gov number, NCT00886925).nnnMETHODSnCirrhotic patients with an acute episode of hepatic encephalopathy (grade II-IV) were randomized to receive albumin (1.5g/kg on day 1 and 1.0g/kg on day 3) or isotonic saline, in addition to the usual treatment (laxatives, rifaximin 1200mg per day). The primary end point was the proportion of patients in which encephalopathy was resolved on day 4. The secondary end points included survival, length of hospital stay, and biochemical parameters.nnnRESULTSnFifty-six patients were randomly assigned to albumin (n=26) or saline (n=30) stratified by the severity of HE. Both groups were comparable regarding to demographic data, liver function, and precipitating factors. The percentage of patients without hepatic encephalopathy at day 4 did not differ between both groups (albumin: 57.7% vs. saline: 53.3%; p>0.05). However, significant differences in survival were found at day 90 (albumin: 69.2% vs. saline: 40.0%; p=0.02).nnnCONCLUSIONSnAlbumin does not improve the resolution of hepatic encephalopathy during hospitalization. However, differences in survival after hospitalization suggest that the development of encephalopathy may identify a subgroup of patients with advanced cirrhosis that may benefit from the administration of albumin.

CLINICAL STUDY: BACTERIAL DNA IN DIAGNOSIS OF SPONTANEOUS BACTERIAL PERITONITIS

Aliment Pharmacol Ther 2011; 33: 275–284

243 ALBUMIN FOR ACUTE EPISODIC HEPATIC ENCEPHALOPATHY (ALFAE STUDY)

242 HYPONATREMIA IN HOSPITALIZED PATIENTS WITH CIRRHOSIS: INTERIM DATA FROM AN OBSERVATIONAL, PROSPECTIVE, MULTI-CENTER, GLOBAL HYPONATREMIA REGISTRY S. Sigal, A. Amin, J. Chiong, J. Dasta, A. Greenberg, J. Verbalis, J. Chiodo, K. Friend. New York University School of Medicine, New York, NY, University of California, Irvine, Loma Linda University, Loma Linda, CA, University of Texas College of Pharmacy, Austin, TX, Duke University Medical Center, Durham, NC, Georgetown University Medical Center, Washington, DC, Otsuka America Pharmaceutical, Inc., Princeton, NJ, USA E-mail: samuel.sigal@nyumc.org