Prognostic significance of hepatic encephalopathy in patients with cirrhosis

Background: There are numerous studies concerning the natural history and p rognostic factors in cirrhosis, the results of which are useful in selectin g liver transplant candidates. However, little attention has been paid to t he prognostic significance of hepatic encephalopathy despite the high frequ ency of this complication. Methods: We reviewed the charts of 111 cirrhotic patients who developed a f irst episode of acute hepatic encephalopathy to determine their survival pr obability and to identify prognostic factors. Results: During follow-up (12+/-17 months), 82 (74%) patients died. The sur vival probability was 42% at 1 year of follow-up and 23% at 3 years. With u nivariate analyses followed by a multivariate analysis, 7 out of 30 clinica l and standard laboratory variables were significantly associated with poor prognosis: male sex, increased serum bilirubin, alkaline phosphatase, pota ssium and blood urea nitrogen, and decreased serum albumin and prothrombin activity. Patients were classified into two groups according to a prognosti c index calculated from these 7 variables. Survival probability at 1 and 3 years was 73% and 38%, respectively, in patients with a low prognostic inde x, and 10% and 3% in patients with a high prognostic index. Conclusion: Hepatic encephalopathy is associated with short survival in cir rhotic patients. Although these patients can be classified into several gro ups with a different prognosis, the survival probability in every group is lower than that currently expected after liver transplantation. Therefore, cirrhotic patients developing a first episode of acute hepatic encephalopat hy should be considered as potential candidates for this therapeutic proced ure.