Infection and systemic inflammation, not ammonia, are associated with Grade 3/4 hepatic encephalopathy, but not mortality in cirrhosis

TY - JOUR

T1 - Infection and systemic inflammation, not ammonia, are associated with Grade 3/4 hepatic encephalopathy, but not mortality in cirrhosis

AU - Shawcross, D. L.

AU - Sharifi, Y.

AU - Canavan, J. B.

AU - Yeoman, A. D.

AU - Abeles, R. D.

AU - Taylor, N. J.

AU - Auzinger, G.

AU - Bernal, W.

AU - Wendon, J. A.

PY - 2011/4

Y1 - 2011/4

N2 - Background & Aims: Patients with cirrhosis are prone to infection which is a frequent precipitant of hepatic encephalopathy (HE). Clinical studies have examined the importance of inflammation and infection in modulating the manifestation of symptoms of HE in acute liver failure and patients with cirrhosis and minimal/low grade HE. It would be logical to presume that this relationship persists in patients who develop severe HE in cirrhosis although this has not been examined to date. Methods: We report the findings of a prospective audit of 100 consecutive patients with cirrhosis admitted between Jan 2000 and March 2008 to a liver Intensive Care Unit (ICU) where HE was the primary indication for admission (59% Grade 3; 41% Grade 4). Haematological and microbiological data were collected at ICU admission, and organ scores and outcomes were recorded. Results: 46% of patients had positive cultures taken within 48 h from admission to ICU [25% blood] and a further 22% were culture negative but had evidence of systemic inflammation (SIRS). SIRS score (p = 0.03) and SOFA score (p = 0.006) were significantly higher in those patients with Grade 4 HE, who were also less likely to survive (p

AB - Background & Aims: Patients with cirrhosis are prone to infection which is a frequent precipitant of hepatic encephalopathy (HE). Clinical studies have examined the importance of inflammation and infection in modulating the manifestation of symptoms of HE in acute liver failure and patients with cirrhosis and minimal/low grade HE. It would be logical to presume that this relationship persists in patients who develop severe HE in cirrhosis although this has not been examined to date. Methods: We report the findings of a prospective audit of 100 consecutive patients with cirrhosis admitted between Jan 2000 and March 2008 to a liver Intensive Care Unit (ICU) where HE was the primary indication for admission (59% Grade 3; 41% Grade 4). Haematological and microbiological data were collected at ICU admission, and organ scores and outcomes were recorded. Results: 46% of patients had positive cultures taken within 48 h from admission to ICU [25% blood] and a further 22% were culture negative but had evidence of systemic inflammation (SIRS). SIRS score (p = 0.03) and SOFA score (p = 0.006) were significantly higher in those patients with Grade 4 HE, who were also less likely to survive (p

U2 - 10.1016/j.jhep.2010.07.045

DO - 10.1016/j.jhep.2010.07.045

M3 - Article

SN - 1600-0641

VL - 54

SP - 640

EP - 649

JO - Journal of Hepatology

JF - Journal of Hepatology

IS - 4

ER -