{
    "abstract": "Management of hepatic encephalopathy relies on the identification and control of precipitating factors (PF). The prognostic value of a PF is unknown, which we aimed to explore.\nSingle-center retrospective study of cirrhotic patients included in a prospective cohort admitted to an intensive care unit (ICU) between 2019 and 2022.\ncirrhosis; overt hepatic encephalopathy; ammonemia \u2265\u00a050\u00a0\u03bcmol/L. PF considered: gastrointestinal bleeding, infection, acute renal injury (AKI), hyponatremia, constipation, non-adherence to ammonia-lowering therapy, TIPS, drugs precipitating overt hepatic encephalopathy. The primary endpoint was 1-year transplant-free survival (TFS). Secondary endpoint was recurrence of hepatic encephalopathy.\n179/497 patients were included (men 72%, age 59, cause of cirrhosis alcohol (ALD)/metALD/MASLD/other in 41/21/6/32%, Child-Pugh A/B/C in 1/18/81%, West Haven grade 2/3/4 in 63/15/22%, MELD score 23). Reasons for admission were: gastrointestinal bleeding (31%), acute encephalopathy (28%), worsening liver function/jaundice (25%), infection (8%), and AKI (8%). All patients (100%) had at least one PF of hepatic encephalopathy (infection [64%], AKI [63%], drugs [41%], bleeding [36%], hyponatremia [22%], TIPS [12%], and constipation [1%]), and 82% had multiple concomitant PF. In-hospital mortality was 50%, and median TFS was 0.8\u00a0months. In multivariate analysis, factors associated with death or liver transplantation were the number of PF, MELD and Child-Pugh scores, ACLF, AKI and infection. Hepatic encephalopathy reoccurred in 42% (median delay of 30\u00a0months).\nAll patients had precipitating factor of hepatic encephalopathy, 82% of them having multiple concomitant precipitating factors. Concomitant multiple precipitating factors were associated with death or liver transplantation. A systematic screening for all precipitating factors of hepatic encephalopathy should be proposed for cirrhotics admitted to intensive care unit.",
    "authors": [
        {
            "affiliation": "Liver Intensive Care Unit, Hepatogastroenterology Department, La Piti\u00e9-Salp\u00eatri\u00e8re Hospital, AP-HP, Sorbonne Universit\u00e9, Paris, France.\nINSERM UMR_S 938, Centre de recherche Saint-Antoine, Maladies m\u00e9taboliques, biliaires et fibro-inflammatoire du foie, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.\nBrain-Liver Piti\u00e9-Salp\u00eatri\u00e8re Study Group (BLIPS), Sorbonne Universit\u00e9, H\u00f4pital de la Piti\u00e9 Salp\u00eatri\u00e8re, Paris, France.",
            "firstname": "Marika",
            "initials": "M",
            "lastname": "Rudler"
        },
        {
            "affiliation": "Liver Intensive Care Unit, Hepatogastroenterology Department, La Piti\u00e9-Salp\u00eatri\u00e8re Hospital, AP-HP, Sorbonne Universit\u00e9, Paris, France.",
            "firstname": "Marie",
            "initials": "M",
            "lastname": "de Matharel"
        },
        {
            "affiliation": "Liver Intensive Care Unit, Hepatogastroenterology Department, La Piti\u00e9-Salp\u00eatri\u00e8re Hospital, AP-HP, Sorbonne Universit\u00e9, Paris, France.\nBrain-Liver Piti\u00e9-Salp\u00eatri\u00e8re Study Group (BLIPS), Sorbonne Universit\u00e9, H\u00f4pital de la Piti\u00e9 Salp\u00eatri\u00e8re, Paris, France.",
            "firstname": "Charlotte",
            "initials": "C",
            "lastname": "Bouzbib"
        },
        {
            "affiliation": "Liver Intensive Care Unit, Hepatogastroenterology Department, La Piti\u00e9-Salp\u00eatri\u00e8re Hospital, AP-HP, Sorbonne Universit\u00e9, Paris, France.\nBrain-Liver Piti\u00e9-Salp\u00eatri\u00e8re Study Group (BLIPS), Sorbonne Universit\u00e9, H\u00f4pital de la Piti\u00e9 Salp\u00eatri\u00e8re, Paris, France.",
            "firstname": "Sarah",
            "initials": "S",
            "lastname": "Mouri"
        },
        {
            "affiliation": "Liver Intensive Care Unit, Hepatogastroenterology Department, La Piti\u00e9-Salp\u00eatri\u00e8re Hospital, AP-HP, Sorbonne Universit\u00e9, Paris, France.\nBrain-Liver Piti\u00e9-Salp\u00eatri\u00e8re Study Group (BLIPS), Sorbonne Universit\u00e9, H\u00f4pital de la Piti\u00e9 Salp\u00eatri\u00e8re, Paris, France.",
            "firstname": "Lyes",
            "initials": "L",
            "lastname": "Kheloufi"
        },
        {
            "affiliation": "INSERM UMR_S 938, Centre de recherche Saint-Antoine, Maladies m\u00e9taboliques, biliaires et fibro-inflammatoire du foie, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.\nBrain-Liver Piti\u00e9-Salp\u00eatri\u00e8re Study Group (BLIPS), Sorbonne Universit\u00e9, H\u00f4pital de la Piti\u00e9 Salp\u00eatri\u00e8re, Paris, France.\nNeurology Intensive Care Unit, Neurology Department, La Piti\u00e9-Salp\u00eatri\u00e8re Hospital, AP-HP, Sorbonne Universit\u00e9, Paris, France.",
            "firstname": "Nicolas",
            "initials": "N",
            "lastname": "Weiss"
        },
        {
            "affiliation": "Liver Intensive Care Unit, Hepatogastroenterology Department, La Piti\u00e9-Salp\u00eatri\u00e8re Hospital, AP-HP, Sorbonne Universit\u00e9, Paris, France.\nBrain-Liver Piti\u00e9-Salp\u00eatri\u00e8re Study Group (BLIPS), Sorbonne Universit\u00e9, H\u00f4pital de la Piti\u00e9 Salp\u00eatri\u00e8re, Paris, France.",
            "firstname": "Philippe",
            "initials": "P",
            "lastname": "Sultanik"
        },
        {
            "affiliation": "Liver Intensive Care Unit, Hepatogastroenterology Department, La Piti\u00e9-Salp\u00eatri\u00e8re Hospital, AP-HP, Sorbonne Universit\u00e9, Paris, France.\nINSERM UMR_S 938, Centre de recherche Saint-Antoine, Maladies m\u00e9taboliques, biliaires et fibro-inflammatoire du foie, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.\nBrain-Liver Piti\u00e9-Salp\u00eatri\u00e8re Study Group (BLIPS), Sorbonne Universit\u00e9, H\u00f4pital de la Piti\u00e9 Salp\u00eatri\u00e8re, Paris, France.",
            "firstname": "Dominique",
            "initials": "D",
            "lastname": "Thabut"
        }
    ],
    "conclusions": "All patients had precipitating factor of hepatic encephalopathy, 82% of them having multiple concomitant precipitating factors. Concomitant multiple precipitating factors were associated with death or liver transplantation. A systematic screening for all precipitating factors of hepatic encephalopathy should be proposed for cirrhotics admitted to intensive care unit.",
    "copyrights": "\u00a9 2024 The Author(s). United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.",
    "doi": "10.1002/ueg2.12706",
    "journal": "United European gastroenterology journal",
    "keywords": [
        "ACLF",
        "ICU",
        "advanced",
        "alcoholic",
        "complications",
        "decompensation",
        "end\u2010stage",
        "failure",
        "portal hypertension",
        "predictors"
    ],
    "methods": null,
    "publication_date": "2025-03-12",
    "pubmed_id": "40066719",
    "results": "179/497 patients were included (men 72%, age 59, cause of cirrhosis alcohol (ALD)/metALD/MASLD/other in 41/21/6/32%, Child-Pugh A/B/C in 1/18/81%, West Haven grade 2/3/4 in 63/15/22%, MELD score 23). Reasons for admission were: gastrointestinal bleeding (31%), acute encephalopathy (28%), worsening liver function/jaundice (25%), infection (8%), and AKI (8%). All patients (100%) had at least one PF of hepatic encephalopathy (infection [64%], AKI [63%], drugs [41%], bleeding [36%], hyponatremia [22%], TIPS [12%], and constipation [1%]), and 82% had multiple concomitant PF. In-hospital mortality was 50%, and median TFS was 0.8\u00a0months. In multivariate analysis, factors associated with death or liver transplantation were the number of PF, MELD and Child-Pugh scores, ACLF, AKI and infection. Hepatic encephalopathy reoccurred in 42% (median delay of 30\u00a0months).",
    "title": "Multiple Concomitant Precipitating Factors of Hepatic Encephalopathy Are Associated With a Poor Prognosis in Patients With Cirrhosis Admitted to Intensive Care Unit.",
    "xml": "<Element 'PubmedArticle' at 0x788506317380>"
}