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Predictors of the recurrence of hepatic encephalopathy in lactulose-treated patients Bajaj JS; Sanyal AJ; Bell D; Gilles H; Heuman DMAliment Pharmacol Ther 2010[May]; 31 (9): 1012-7BACKGROUND: 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.|Adolescent[MESH]|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Female[MESH]|Gastrointestinal Agents/*therapeutic use[MESH]|Hepatic Encephalopathy/etiology/*therapy[MESH]|Humans[MESH]|Lactulose/*adverse effects/therapeutic use[MESH]|Liver Cirrhosis/complications[MESH]|Male[MESH]|Middle Aged[MESH]|Patient Compliance[MESH]|Recurrence[MESH]|Retrospective Studies[MESH]|Young Adult[MESH] |
