Metabolic Brain Disease

, Volume 34, Issue 1, pp 213–221 | Cite as

Establishment and evaluation of a model for predicting 3-month mortality in Chinese patients with hepatic encephalopathy

  • Yanping Cui
  • Shan Guan
  • Jie Ding
  • Yukai He
  • Qingfang Li
  • Sikui Wang
  • Huiling SunEmail author
Original Article


Hepatic encephalopathy (HE) is a serious complication of liver disease. To establish a model for predicting 3-month mortality in patients with HE in China. This retrospective study included 609 patients with HE admitted to the Peoples’ Hospital, Liaocheng City, China (August 2006 to January 2016). Patients were allocated to a modeling (n = 409) or validation (n = 200) group. Demographic/clinical characteristics, laboratory test results, Model for End Stage Liver Disease (MELD) score and Child-Turcotte-Pugh (CTP) score were extracted from medical records. A model for predicting death within 3 months after admission was established using logistic regression analysis (modeling group). Model validity (validation group) was assessed using receiver operating characteristic (ROC) curve analysis. 270/409(66.0%) patients died in the modeling group and 142/203(70.0%) died in the validation group. Compared with survivors, patients who died had more severe HE, and higher MELD score, CTP score, incidence of complications including hepatorenal syndrome (HRS) and upper gastrointestinal bleeding, and values for laboratory parameters including red blood cell count(RBC) and total bilirubin(TBIL)(P < 0.05). Regression analysis revealed RBC, TBIL, HE stage, HRS and upper gastrointestinal bleeding as independent factors associated with death (P < 0.05). The area under the ROC curve (AUC) for the model was 0.931.The model had a higher Youden index than MELD or CTP scores and predicted death in the validation group with a sensitivity of 83.1% and specificity of 93.4%. The established model has superior performance to MELD and CTP scores for predicting mortality in patients with HE.


Hepatic encephalopathy Mortality Prognosis MELD score Child-Turcotte-Pugh score 


Compliance with ethical standards

Disclosure of potential conflicts of interest

The authors declare that they have no conflict of interest.

Research involving human participants

The study was approved by the ethics committee of the Peoples’ Hospital of Liaocheng City.

Informed consent

Due to the retrospective and anonymized design of the study, written consent from the participants was deemed not to be required.


  1. Attia KA, Ackoundou-N'guessan KC, N'Dri-Yoman AT, Mahassadi AK, Messou E, Bathaix YF, Kissi YH (2008) Child-Pugh-Turcott versus Meld score for predicting survival in a retrospective cohort of black African cirrhotic patients. World J Gastroenterol 14:286–291CrossRefGoogle Scholar
  2. Bajaj JS, Wade JB, Gibson DP, Heuman DM, Thacker LR, Sterling RK, Stravitz RT, Luketic V, Fuchs M, White MB, Bell DE, Gilles H, Morton K, Noble N, Puri P, Sanyal AJ (2011) The multi-dimensional burden of cirrhosis and hepatic encephalopathy on patients and caregivers. Am J Gastroenterol 106:1646–1653. CrossRefPubMedPubMedCentralGoogle Scholar
  3. Botta F, Giannini E, Romagnoli P, Fasoli A, Malfatti F, Chiarbonello B, Testa E, Risso D, Colla G, Testa R (2003) MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study. Gut 52:134–139CrossRefGoogle Scholar
  4. Bustamante J, Rimola A, Ventura PJ, Navasa M, Cirera I, Reggiardo V, Rodes J (1999) Prognostic significance of hepatic encephalopathy in patients with cirrhosis. J Hepatol 30:890–895CrossRefGoogle Scholar
  5. Chinese Society of Gastroenterology, Chinese Society of Hepatology CMA, Chinese Medical Association (2013) Consensus on the diagnosis and treatment of hepatic encephalopathy. Zhonghua Gan Zang Bing Za Zhi 21:641–651Google Scholar
  6. Christensen E, Krintel JJ, Hansen SM, Johansen JK, Juhl E (1989) Prognosis after the first episode of gastrointestinal bleeding or coma in cirrhosis. Survival and prognostic factors. Scand J Gastroenterol 24:999–1006CrossRefGoogle Scholar
  7. Cichoz-Lach H, Michalak A (2013) Current pathogenetic aspects of hepatic encephalopathy and noncirrhotic hyperammonemic encephalopathy. World J Gastroenterol 19:26–34. CrossRefPubMedPubMedCentralGoogle Scholar
  8. Conn HO, Leevy CM, Vlahcevic ZR, Rodgers JB, Maddrey WC, Seeff L, Levy LL (1977) Comparison of lactulose and neomycin in the treatment of chronic portal-systemic encephalopathy. A double blind controlled trial Gastroenterology 72:573–583PubMedGoogle Scholar
  9. D'Amico G, Garcia-Tsao G, Pagliaro L (2006) Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol 44:217–231. CrossRefPubMedGoogle Scholar
  10. Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT (2002) Hepatic encephalopathy--definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th world congresses of gastroenterology, Vienna, 1998. Hepatology 35:716–721. CrossRefPubMedGoogle Scholar
  11. Hassanein TI, Tofteng F, Brown RS Jr, McGuire B, Lynch P, Mehta R, Larsen FS, Gornbein J, Stange J, Blei AT (2007) Randomized controlled study of extracorporeal albumin dialysis for hepatic encephalopathy in advanced cirrhosis. Hepatology 46:1853–1862. CrossRefPubMedPubMedCentralGoogle Scholar
  12. Jeong JH, Park IS, Kim DH, Kim SC, Kang C, Lee SH, Kim TY, Lee SB (2016) CLIF-SOFA score and SIRS are independent prognostic factors in patients with hepatic encephalopathy due to alcoholic liver cirrhosis. Medicine (Baltimore) 95:e3935. CrossRefGoogle Scholar
  13. Kim HJ, Lee HW (2013) Important predictor of mortality in patients with end-stage liver disease. Clin Mol Hepatol 19:105–115. CrossRefPubMedPubMedCentralGoogle Scholar
  14. Londono MC, Cardenas A, Guevara M, Quinto L, de Las Heras D, Navasa M, Rimola A, Garcia-Valdecasas JC, Arroyo V, Gines P (2007) MELD score and serum sodium in the prediction of survival of patients with cirrhosis awaiting liver transplantation. Gut 56:1283–1290. CrossRefPubMedPubMedCentralGoogle Scholar
  15. Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC (2000) A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology 31:864–871. CrossRefPubMedGoogle Scholar
  16. Parekh PJ, Balart LA (2015) Ammonia and its role in the pathogenesis of hepatic encephalopathy. Clin Liver Dis 19:529–537. CrossRefPubMedGoogle Scholar
  17. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R (1973) Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 60:646–649CrossRefGoogle Scholar
  18. Said A, Williams J, Holden J, Remington P, Gangnon R, Musat A, Lucey MR (2004) Model for end stage liver disease score predicts mortality across a broad spectrum of liver disease. J Hepatol 40:897–903. CrossRefPubMedGoogle Scholar
  19. Samada Suarez M, Hernandez Perera JC, Ramos Robaina L, Barroso Marquez L, Gonzalez Rapado L, Cepero Valdes M, Hernandez Rivero H, Abdo Cuza A, Valdes AR, Perez Bernal J, Bernardos A (2008) Factors that predict survival in patients with cirrhosis considered for liver transplantation. Transplant Proc 40:2965–2967. CrossRefPubMedGoogle Scholar
  20. Saunders JB, Walters JR, Davies AP, Paton A (1981) A 20-year prospective study of cirrhosis. Br Med J (Clin Res Ed) 282:263–266CrossRefGoogle Scholar
  21. Simon-Talero M, Garcia-Martinez R, Torrens M, Augustin S, Gomez S, Pereira G, Guevara M, Gines P, Soriano G, Roman E, Sanchez-Delgado J, Ferrer R, Nieto JC, Sunye P, Fuentes I, Esteban R, Cordoba J (2013) Effects of intravenous albumin in patients with cirrhosis and episodic hepatic encephalopathy: a randomized double-blind study. J Hepatol 59:1184–1192. CrossRefPubMedGoogle Scholar
  22. Singal AK, Kamath PS (2013) Model for end-stage liver disease. J Clin Exp Hepatol 3:50–60. CrossRefPubMedGoogle Scholar
  23. Stepanova M, Mishra A, Venkatesan C, Younossi ZM (2012) In-hospital mortality and economic burden associated with hepatic encephalopathy in the United States from 2005 to 2009. Clin Gastroenterol Hepatol 10 e1031:1034–1041. CrossRefGoogle Scholar
  24. Stewart CA, Malinchoc M, Kim WR, Kamath PS (2007) Hepatic encephalopathy as a predictor of survival in patients with end-stage liver disease. Liver Transpl 13:1366–1371. CrossRefPubMedGoogle Scholar
  25. Suraweera D, Sundaram V, Saab S (2016) Evaluation and Management of Hepatic Encephalopathy: current status and future directions. Gut Liver 10:509–519. CrossRefPubMedPubMedCentralGoogle Scholar
  26. Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, Weissenborn K, Wong P (2014) Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the liver. Hepatology 60:715–735. CrossRefPubMedGoogle Scholar
  27. Vlachogiannakos J, Kougioumtzian A, Triantos C, Viazis N, Sgouros S, Manolakopoulos S, Saveriadis A, Markoglou C, Economopoulos T, Karamanolis DG (2007) Clinical trial: the effect of somatostatin vs. octreotide in preventing post-endoscopic increase in hepatic venous pressure gradient in cirrhotics with bleeding varices. Aliment Pharmacol Ther 26:1479–1487. CrossRefPubMedGoogle Scholar
  28. Weissenborn K, Bokemeyer M, Krause J, Ennen J, Ahl B (2005) Neurological and neuropsychiatric syndromes associated with liver disease. Aids 19(Suppl 3):S93–S98CrossRefGoogle Scholar
  29. Yoneyama K, Nebashi Y, Kiuchi Y, Shibata M, Mitamura K (2004) Prognostic index of cirrhotic patients with hepatic encephalopathy with and without hepatocellular carcinoma. Dig Dis Sci 49:1174–1180CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Yanping Cui
    • 1
  • Shan Guan
    • 1
  • Jie Ding
    • 2
  • Yukai He
    • 1
  • Qingfang Li
    • 1
  • Sikui Wang
    • 1
  • Huiling Sun
    • 3
    Email author
  1. 1.Department of Liver DiseaseLiaocheng People’s HospitalLiaochengChina
  2. 2.Central LaboratoryLiaocheng People’s HospitalLiaochengChina
  3. 3.Department of GastroenterologyLiaocheng People’s HospitalLiaochengChina

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