Hepatology (Baltimore, Md.) · 2025
Acute encephalopathy without hyperammonemia has a different presentation than overt HE and displays a similarly severe prognosis.
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Desplats Victor, Haudebourg Luc, Verger Nicolas, Assaraf Julie, Mouri Sarah, Bouzbib Charlotte, Bonnefont-Rousselot Dominique, Alkouri Rana, Sakka Mehdi, Sultanik Philippe, Leproux Apolline, Weiss Nicolas, Rudler Marika, Thabut Dominique
Аннотация
BACKGROUND AND AIMS: In cirrhosis, some patients display acute encephalopathy without hyperammonemia (NonHep E) which is not considered as overt hepatic encephalopathy (OHE). We aimed to assess the prevalence and characteristics of NonHep E and OHE in patients with cirrhosis displaying acute encephalopathy, assess their respective prognosis and compare it to other causes of acute decompensation with/without hyperammonemia.
APPROACH AND RESULTS: We conducted a retrolective analysis from a prospective cohort of patients hospitalized for acute decompensation. Hyperammonemia was defined by NH3 >50 µmol/L. Patients were divided into 4 groups: OHE (encephalopathy and NH3 >50 µmol/L: group 1), NonHep E (encephalopathy and NH3≤50 µmol/L, group 2), and 2 control groups with acute decompensation/without encephalopathy (NH3≤50 µmol/L [group 3] or NH3>50 µmol/L [group 4]). Five hundred thirty patients were included (168 group 1, 76 group 2, 125 group 3, and 161 group 4). Overall, 168/244 (69%) of patients with acute encephalopathy displayed OHE, and 76/244 (31%) NonHep E. NonHep E patients were significantly more exposed to medications than patients with OHE. One-year transplant-free survival was 60.4%. In multivariable analysis, compared to patients with normal ammonemia and without encephalopathy, OHE was independently associated with a lower 1-year transplant-free survival (1.58 [95% CI: 1.14-2.18, p =0.006]). Patients with OHE did not display a higher risk of death or transplantation than NonHep E patients (HR: 1.27, 95% CI: 0.91-1.77, p =0.161).
CONCLUSIONS: NonHep E accounts for one-third of admissions for acute encephalopathy and displays as severe a prognosis as OHE. OHE is independently associated with lower transplant-free survival at 1 year.
APPROACH AND RESULTS: We conducted a retrolective analysis from a prospective cohort of patients hospitalized for acute decompensation. Hyperammonemia was defined by NH3 >50 µmol/L. Patients were divided into 4 groups: OHE (encephalopathy and NH3 >50 µmol/L: group 1), NonHep E (encephalopathy and NH3≤50 µmol/L, group 2), and 2 control groups with acute decompensation/without encephalopathy (NH3≤50 µmol/L [group 3] or NH3>50 µmol/L [group 4]). Five hundred thirty patients were included (168 group 1, 76 group 2, 125 group 3, and 161 group 4). Overall, 168/244 (69%) of patients with acute encephalopathy displayed OHE, and 76/244 (31%) NonHep E. NonHep E patients were significantly more exposed to medications than patients with OHE. One-year transplant-free survival was 60.4%. In multivariable analysis, compared to patients with normal ammonemia and without encephalopathy, OHE was independently associated with a lower 1-year transplant-free survival (1.58 [95% CI: 1.14-2.18, p =0.006]). Patients with OHE did not display a higher risk of death or transplantation than NonHep E patients (HR: 1.27, 95% CI: 0.91-1.77, p =0.161).
CONCLUSIONS: NonHep E accounts for one-third of admissions for acute encephalopathy and displays as severe a prognosis as OHE. OHE is independently associated with lower transplant-free survival at 1 year.