P- 39 clinical significance of grade 1 hepatic encephalopathy in patients hospitalized for complications of cirrhosis

Introduction and Objectives: Recent guidelines recommended grouping grade 1 and minimal HE under the term “covert HE.” However, minimal HE is not usually investigated in hospitalized patients and there are very little data about the impact of grade 1 HE in patients admitted for complications of cirrhosis. This study aimed to investigate factors associated with the presence of grade 1 HE and its prognostic impact in patients hospitalized for complications of cirrhosis Materials and Methods: prospective cohort study that included 238 patients either without HE or with grade 1 HE on the first day of hospitalization. All examiners were fourth-year fellows with at least one year of experience in clinical hepatology and trained by the senior investigators specifically for the use of West-Haven criteria. Minimal hepatic was not evaluated. Results: The mean age was 54.2 ± 11.6 years, mean MELD was 16.4 ± 6.7. Grade 1 HE was observed in 62 patients (26.1%) and was associated with ascites, Child-Pugh C, ACLF, higher total bilirubin, INR, MELD, and CLIF-SOFA. Progression to grades 2/3/4 HE (overt HE) up to day 3 of hospitalization occurred in 7.1% of the patients and was independently associated with bacterial infection (OR = 4.934, IC 95% 1.415-17.199, P=0.012) and grade 1 HE (OR = 3.937, IC 95% 1.261-12.298, P=0.018). The progression rate to overt HE was four times higher among subjects with grade 1 HE as compared to those without HE (16.1% vs. 4.0%, P = 0.003). The 90-day Kaplan-Meier survival probability was significantly lower among patients with grade 1 (71.0% vs. 84.1%, P = 0.018) (figure 1). Conclusions: When compared to individuals without HE at admission, grade 1 HE was associated with parameters of more advanced liver disease and more severe acute decompensation. Patients with grade 1 HE exhibited worse evolution of mental state and higher mortality, reinforcing the practical importance of more subtle clinical findings.