Impact of sustained viral response in the evolution of minimal hepatic encephalopathy: A prospective pilot study
Introduction and aims: To determine the prevalence of minimal hepatic encephalopathy(MHE) in patients with liver cirrhosis (LC) due to hepatitis C virus (HCV) infection and to evaluate the impact of sustained viral response (SVR) on MHE. Materials and methods: We performed a prospective study using...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2019-05-01
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| Series: | Annals of Hepatology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S166526811930047X |
| _version_ | 1818899649733328896 |
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| author | Marta Hernández-Conde Carlos Fernández-Carrillo Elba Llop Christie Perelló Marta López-Gómez José L. Martínez-Porras Natalia Fernández-Puga José L. Calleja |
| author_facet | Marta Hernández-Conde Carlos Fernández-Carrillo Elba Llop Christie Perelló Marta López-Gómez José L. Martínez-Porras Natalia Fernández-Puga José L. Calleja |
| author_sort | Marta Hernández-Conde |
| collection | DOAJ |
| description | Introduction and aims: To determine the prevalence of minimal hepatic encephalopathy(MHE) in patients with liver cirrhosis (LC) due to hepatitis C virus (HCV) infection and to evaluate the impact of sustained viral response (SVR) on MHE. Materials and methods: We performed a prospective study using MHE screening and follow-up on patients with HCV and LC. The patients were evaluated at the beginning of treatment and 24 weeks after treatment. Results: 64 patients were included. 51.6% were male, the median age was 62 years, Child-Pugh classification A/B/C 93.8%/4.7%/1.6% and median MELD was 8.3. Prior hydropic decompensation was present in 11 patients. Median values of liver stiffness, as measured by transient elastography (TE) were 22.8 kPa. Indirect signs of portal hypertension (PH) were present in 53.1% of patients, with a mean of 11.9 mmHg among the ones with a measurement of the hepatic venous pressure gradient. The prevalence of MHE before treatment was 26.6%. After treatment, 98.4% of patients achieved SVR. The presence of MHE at 24 weeks post-treatment had an statistically significant association with the presence of pre-treatment MHE (80% vs. 21.6%; p < 0.01), higher MELD scores at 24-weeks post-treatment (9.8 vs. 8; p = 0.02), higher Child-Pugh scores at 24-weeks post-treatment (p = 0.04), higher baseline INR levels (1.4 vs. 1.1; p < 0.001) and with the presence of indirect signs of PH (100% vs. 47.1%; p = 0.02). During follow-up, those patients without MHE at 24 weeks post-treatment had a higher probability of experiencing an improvement in post-treatment TE (80.9% vs. 40%, p = 0.04). Conclusion: We found that SVR may lead to MHE resolution in a considerable proportion of patients, which has potential implications for disease prognosis. |
| first_indexed | 2024-12-19T19:51:20Z |
| format | Article |
| id | doaj.art-2ccad4cdaeb24ff68715cef66dad995f |
| institution | Directory Open Access Journal |
| issn | 1665-2681 |
| language | English |
| last_indexed | 2024-12-19T19:51:20Z |
| publishDate | 2019-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Annals of Hepatology |
| spelling | doaj.art-2ccad4cdaeb24ff68715cef66dad995f2022-12-21T20:07:58ZengElsevierAnnals of Hepatology1665-26812019-05-01183429433Impact of sustained viral response in the evolution of minimal hepatic encephalopathy: A prospective pilot studyMarta Hernández-Conde0Carlos Fernández-Carrillo1Elba Llop2Christie Perelló3Marta López-Gómez4José L. Martínez-Porras5Natalia Fernández-Puga6José L. Calleja7Department of Gastroenterology and Hepatology. Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, SpainDepartment of Gastroenterology and Hepatology. Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, SpainDepartment of Gastroenterology and Hepatology. Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, SpainDepartment of Gastroenterology and Hepatology. Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, SpainDepartment of Gastroenterology and Hepatology. Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, SpainDepartment of Gastroenterology and Hepatology. Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, SpainDepartment of Gastroenterology and Hepatology. Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, SpainCorresponding author at: Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, Calle Manuel de Falla, 1, 28222 Majadahonda, Madrid, Spain.; Department of Gastroenterology and Hepatology. Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, SpainIntroduction and aims: To determine the prevalence of minimal hepatic encephalopathy(MHE) in patients with liver cirrhosis (LC) due to hepatitis C virus (HCV) infection and to evaluate the impact of sustained viral response (SVR) on MHE. Materials and methods: We performed a prospective study using MHE screening and follow-up on patients with HCV and LC. The patients were evaluated at the beginning of treatment and 24 weeks after treatment. Results: 64 patients were included. 51.6% were male, the median age was 62 years, Child-Pugh classification A/B/C 93.8%/4.7%/1.6% and median MELD was 8.3. Prior hydropic decompensation was present in 11 patients. Median values of liver stiffness, as measured by transient elastography (TE) were 22.8 kPa. Indirect signs of portal hypertension (PH) were present in 53.1% of patients, with a mean of 11.9 mmHg among the ones with a measurement of the hepatic venous pressure gradient. The prevalence of MHE before treatment was 26.6%. After treatment, 98.4% of patients achieved SVR. The presence of MHE at 24 weeks post-treatment had an statistically significant association with the presence of pre-treatment MHE (80% vs. 21.6%; p < 0.01), higher MELD scores at 24-weeks post-treatment (9.8 vs. 8; p = 0.02), higher Child-Pugh scores at 24-weeks post-treatment (p = 0.04), higher baseline INR levels (1.4 vs. 1.1; p < 0.001) and with the presence of indirect signs of PH (100% vs. 47.1%; p = 0.02). During follow-up, those patients without MHE at 24 weeks post-treatment had a higher probability of experiencing an improvement in post-treatment TE (80.9% vs. 40%, p = 0.04). Conclusion: We found that SVR may lead to MHE resolution in a considerable proportion of patients, which has potential implications for disease prognosis.http://www.sciencedirect.com/science/article/pii/S166526811930047XHCVMHEDirect-acting antiviralsCritical flicker frequency |
| spellingShingle | Marta Hernández-Conde Carlos Fernández-Carrillo Elba Llop Christie Perelló Marta López-Gómez José L. Martínez-Porras Natalia Fernández-Puga José L. Calleja Impact of sustained viral response in the evolution of minimal hepatic encephalopathy: A prospective pilot study Annals of Hepatology HCV MHE Direct-acting antivirals Critical flicker frequency |
| title | Impact of sustained viral response in the evolution of minimal hepatic encephalopathy: A prospective pilot study |
| title_full | Impact of sustained viral response in the evolution of minimal hepatic encephalopathy: A prospective pilot study |
| title_fullStr | Impact of sustained viral response in the evolution of minimal hepatic encephalopathy: A prospective pilot study |
| title_full_unstemmed | Impact of sustained viral response in the evolution of minimal hepatic encephalopathy: A prospective pilot study |
| title_short | Impact of sustained viral response in the evolution of minimal hepatic encephalopathy: A prospective pilot study |
| title_sort | impact of sustained viral response in the evolution of minimal hepatic encephalopathy a prospective pilot study |
| topic | HCV MHE Direct-acting antivirals Critical flicker frequency |
| url | http://www.sciencedirect.com/science/article/pii/S166526811930047X |
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