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Predictors of the recurrence of hepatic encephalopathy in lactulose-treated patients.
Aliment Pharmacol Ther. 2010 May; 31(9):1012-7.AP

Abstract

BACKGROUND

Lactulose is considered first-line therapy for hepatic encephalopathy. However, the effect of adherence with lactulose on recurrence of hepatic encephalopathy outside clinical trials remains unclear.

AIM

To determine the association of lactulose use with recurrence of hepatic encephalopathy episodes.

METHODS

Patients with cirrhosis who were initiated on lactulose after an index hepatic encephalopathy episode in a liver-transplant centre were retrospectively reviewed. Recurrence of hepatic encephalopathy, precipitating factors and adherence on lactulose were investigated using chart review and electronic pharmacy records. Patients with/without hepatic encephalopathy recurrence were compared, and predictors of recurrence were analysed.

RESULTS

A total of 137 patients with cirrhosis (age 55 +/- 6years, MELD 17 +/- 7) who were initiated on lactulose after the index hepatic encephalopathy episode were included. Of these, 103 patients developed recurrent hepatic encephalopathy 9 +/- 1 months after their index episode; 39 (38%) of these were not adherent on lactulose, 56 (54%) were adherent and 8 (8%) had lactulose-associated dehydration leading to recurrence. Recurrent hepatic encephalopathy precipitants in lactulose-adherent patients were sepsis (19%), GI bleeding (15%), hyponatremia (4%) and TIPS (7%). Overall, all patients who did not suffer recurrence were adherent on lactulose. In contrast, the adherence rate for those who recurred was only 64% (P = 0.00001). On multivariate regression, lactulose non-adherence (OR 3.26) and MELD score (OR 1.14) were the factors that predicted recurrence.

CONCLUSION

Lactulose non-adherence and lactulose-associated dehydration were associated with nearly half of recurrent hepatic encephalopathy episodes.

Authors+Show Affiliations

Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA 23249, USA. jsbajaj@vcu.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20136802

Citation

Bajaj, J S., et al. "Predictors of the Recurrence of Hepatic Encephalopathy in Lactulose-treated Patients." Alimentary Pharmacology & Therapeutics, vol. 31, no. 9, 2010, pp. 1012-7.
Bajaj JS, Sanyal AJ, Bell D, et al. Predictors of the recurrence of hepatic encephalopathy in lactulose-treated patients. Aliment Pharmacol Ther. 2010;31(9):1012-7.
Bajaj, J. S., Sanyal, A. J., Bell, D., Gilles, H., & Heuman, D. M. (2010). Predictors of the recurrence of hepatic encephalopathy in lactulose-treated patients. Alimentary Pharmacology & Therapeutics, 31(9), 1012-7. https://doi.org/10.1111/j.1365-2036.2010.04257.x
Bajaj JS, et al. Predictors of the Recurrence of Hepatic Encephalopathy in Lactulose-treated Patients. Aliment Pharmacol Ther. 2010;31(9):1012-7. PubMed PMID: 20136802.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of the recurrence of hepatic encephalopathy in lactulose-treated patients. AU - Bajaj,J S, AU - Sanyal,A J, AU - Bell,D, AU - Gilles,H, AU - Heuman,D M, Y1 - 2010/02/05/ PY - 2010/2/9/entrez PY - 2010/2/9/pubmed PY - 2010/11/6/medline SP - 1012 EP - 7 JF - Alimentary pharmacology & therapeutics JO - Aliment. Pharmacol. Ther. VL - 31 IS - 9 N2 - BACKGROUND: Lactulose is considered first-line therapy for hepatic encephalopathy. However, the effect of adherence with lactulose on recurrence of hepatic encephalopathy outside clinical trials remains unclear. AIM: To determine the association of lactulose use with recurrence of hepatic encephalopathy episodes. METHODS: Patients with cirrhosis who were initiated on lactulose after an index hepatic encephalopathy episode in a liver-transplant centre were retrospectively reviewed. Recurrence of hepatic encephalopathy, precipitating factors and adherence on lactulose were investigated using chart review and electronic pharmacy records. Patients with/without hepatic encephalopathy recurrence were compared, and predictors of recurrence were analysed. RESULTS: A total of 137 patients with cirrhosis (age 55 +/- 6years, MELD 17 +/- 7) who were initiated on lactulose after the index hepatic encephalopathy episode were included. Of these, 103 patients developed recurrent hepatic encephalopathy 9 +/- 1 months after their index episode; 39 (38%) of these were not adherent on lactulose, 56 (54%) were adherent and 8 (8%) had lactulose-associated dehydration leading to recurrence. Recurrent hepatic encephalopathy precipitants in lactulose-adherent patients were sepsis (19%), GI bleeding (15%), hyponatremia (4%) and TIPS (7%). Overall, all patients who did not suffer recurrence were adherent on lactulose. In contrast, the adherence rate for those who recurred was only 64% (P = 0.00001). On multivariate regression, lactulose non-adherence (OR 3.26) and MELD score (OR 1.14) were the factors that predicted recurrence. CONCLUSION: Lactulose non-adherence and lactulose-associated dehydration were associated with nearly half of recurrent hepatic encephalopathy episodes. SN - 1365-2036 UR - https://www.unboundmedicine.com/medline/citation/20136802/Predictors_of_the_recurrence_of_hepatic_encephalopathy_in_lactulose_treated_patients_ L2 - https://doi.org/10.1111/j.1365-2036.2010.04257.x DB - PRIME DP - Unbound Medicine ER -