A Validation of the Bilirubin-Albumin-Betablocker-Statin Score to Predict the Development of Hepatic Encephalopathy in Patients With Liver Cirrhosis

Background: Hepatic encephalopathy (HE) is a frequent complication of liver cirrhosis and a common reason for hospital admission and readmission. There are no available risk scores to predict the development of HE, but the Bilirubin-Albumin-Beta-Blocker-Statin (BABS) score has been proposed as a tool for risk stratification. The aim of the study was to validate the BABS score for the prediction of HE in patients with liver cirrhosis. Methods: Patients from Mainz, Germany with liver cirrhosis but without baseline HE (n = 398) were included. The primary outcome was the development of HE, defined as HE grade ≥1 according to the West Haven Criteria and mean follow up time was 514 days (range: 14-1280 days). Risk scores were constructed with baseline data resulting in a BABS score of <-10 (low), -9 to 20 (intermediate), and ≥21 (high). Kaplan-Meier curves were modelled showing time to HE and Cox regressions were performed to estimate hazard ratios. Results: The mean age was 59 years (±10.3 SD), 40% were women and the mean level of bilirubin and albumin were 2.20 mg/dL (±3.12 SD) and 2.4 mg/dL (±0.69 SD), respectively. Half of the patients used beta-blockers and 10% of patients used statins. The mean BABS score was 11.7 (±18.4 SD) and 55 (13.8%) patients developed HE. Patients who developed HE had higher levels of bilirubin and lower levels of albumin compared to those who did not develop HE. The use of beta-blockers was higher in patients developing HE, while the use of statins was lower. Patients who developed HE had a higher BABS score of 27.8 (±14.5 SD) compared to patients who did not develop HE 9.1 (±17.69 SD) (P<0.0001). None of the patients with a BABS score <-10 developed HE, 10% of patients with a score between -9 and 20 developed HE and 30% of patients with a score ≥21 developed HE. Conclusion: These data demonstrates that the BABS score can be used for risk stratification of HE (see Figures 1 and 2).Figure 1.: Proportion of patients developing HE stratified by risk score.Figure 2.: Kaplan-Meier curve of stratified risk scores for development of HE.