Anemia and hypoalbuminemia are associated with hepatic encephalopathy and mortality after portal hypertension-related bleeding.

BACKGROUND/

OBJECTIVES

Modifiable factors may influence prognosis in patients with cirrhosis and portal hypertension-related bleeding (PHB). This study characterized metabolic and hematological profiles during and after PHB and evaluated their impact on liver-related events and mortality.

PATIENTS AND

METHODS

Observational, single-center, retrospective cohort study including patients with cirrhosis admitted for PHB and followed for 1 year. Epidemiological, clinical, analytical, and hemodynamic data were collected. Anemia was defined according to World Health Organization criteria, and the hypoalbuminemia threshold was established using receiver operating characteristic (ROC) curves and the Youden index. Risk factors for liver-related events and death were assessed using Cox regression and cumulative incidence functions with competing risks.

RESULTS

Forty-eight patients were included (60.4% men; 35.5% alcohol-related cirrhosis), with a median age of 63 years (IQR 55-74). During one-year follow-up, hepatic encephalopathy (HE) was the most frequent liver-related event (21%). Hypoalbuminemia was independently associated with an increased risk of hepatic encephalopathy at 6 months (sHR 5.70, 95% CI 1.36-23.8, p=0.017) and at 1 year (sHR 7.28, 95% CI 1.08-48.8, p=0.041). One-year survival was significantly lower in patients with HE (60% vs. 100%, p<0.001), hypoalbuminemia (60% vs. 96.7%, p=0.005), and anemia (80% vs. 100%, p=0.016). Patients receiving red blood cell transfusion during PHB showed better liver function at 1 year (median MELD 9 [IQR 7-10] vs. 10 [IQR 9.8-12.5], p=0.017).

CONCLUSIONS

Anemia and hypoalbuminemia are potentially modifiable factors associated with increased risk of HE and mortality within 1 year after PHB. Whether correction of anemia and nutritional status improves prognosis remains to be determined.