Evaluation of the impact of rehospitalization in the management of hepatic encephalopathy

Abstract

Background

Overt hepatic encephalopathy (HE), which is associated with neuropsychiatric symptoms and neuromuscular dysfunction in patients with liver cirrhosis, is often managed in the hospital setting. Approximately 60% of eligible patients do not receive prophylactic therapy after an overt HE episode.

Objective

The aim of this review is to evaluate the impact of rehospitalization on costs and clinical outcomes in HE.

Methods

A PubMed search of English-language articles through July 9, 2014 was conducted, and bibliographies of identified publications were reviewed. Abstracts from relevant professional society meetings from 2010 to 2014 were searched. The selected references and abstracts reported on the prevalence, costs, or clinical consequences of rehospitalization in adults with HE.

Data synthesis

HE is a key reason for readmission among patients hospitalized for complications of cirrhosis. Almost 40% of patients previously hospitalized for HE may be readmitted within 1 year for HE-related reasons. Furthermore, in-hospital US mortality for patients admitted for HE is about 7% to 15%. Recurrent HE and hospitalization for cirrhosis complications are associated with impaired quality of life. In addition, recurrences (especially those requiring hospitalization) may contribute to persistent cognitive deficits (eg, impairments in reaction time, attention, and working memory) after resolution of an acute episode of overt HE.

Conclusion

The economic and clinical consequences of rehospitalization for patients with overt HE underscore the importance of secondary prevention and highlight the need to identify reasons for the undertreatment of patients after hospitalization for overt HE.

Keywords:

• hospitalization
• lactulose
• prevention
• rifaximin
• cirrhosis
• cognitive impairment

Acknowledgments

Technical editorial and medical writing assistance was provided, under the direction of the author, by Larry Nelson, PhD, and Mary Beth Moncrief, PhD, Synchrony Medical Communications, LLC, West Chester, PA, USA. Funding for this support was provided by Salix Pharmaceuticals, Inc., Raleigh, NC, USA.

Disclosure

Dr Saab serves as a consultant and on the speakers’ bureau for and holds stock in Salix Pharmaceuticals, Inc. The author declares no other conflicts of interest in this work.