Disclosures: Young-Suk Lim – Advisory Committees or Review Panels: Bayer Healthcare, Gil-ead Sciences; Grant/Research Support: Bayer Healthcare, BMS, Gilead Sciences, Novartis Han Chu Lee – Grant/Research Support: Medigen Biotechnology Co., Novartis, Roche, Bayer HealthCare, Bristol-Myers Squibb, INC research, Boehringer Ingel-heim, Taiho Pharmaceutical Co., Yuhan Co. The following people
have nothing to disclose: Jihyun An, Ju Hyun Shim, Kang Mo Kim, Jonggi Choi, Gi-Ae Kim, Hyung-Don Kim, Young Joo Yang, Yeonjung Ha, Mi-Jung Jun, Jee Eun Yang, Young-Hwa Chung, Yung Sang Lee, Dong Jin Suh Hepatic encephalopathy (HE) is considered reversible regarding mental status but may not be from a cognitive standpoint. This may have implications for brain recovery post-transplant and needs evaluation with multi-center studies.
Aim: evaluate persistence of cognitive impairment in HE compared to no-HE patients in a multi-center study. Methods: Outpatient BMN 673 clinical trial cirrhotics from 3 centers (Virginia, Rome & Ohio) underwent cognitive testing including paper-pencil (psychometric hepatic enceph-alopathy score:PHES) & inhibitory control test (ICT; outcomes lures) ≥7 days apart without intervening disease changes. The 1st half of ICT is identical to the 2nd half. Therefore subjects with intact learning ability should improve (have less lures) in the 2nd compared to the 1st half. PHES has 6 tests (number conn A/B:NC A/B, digit symbol: DS, serial dotting:SD & line tracing errors/time:LTTe/t). Learning between test administrations selleck products & ICT lure changes were compared in HE vs. no-HE pts. Results: 187 pts (77 VA, 50 Rome, 30 OH, 59yrs, MELD 11, 12 yrs educ) were included. Italian pts were significantly older & less educated than the rest but MELD was similar. 20% had prior HE (24 VA, 9 Rome, 3 OH) controlled on meds (100% lactulose,25% also on rifaximin). HE pts had a higher MELD score (16 vs 10, p<0.0001).
Baseline visit: HE pts had worse performance on all tests selleck screening library compared to no-HE pts. While no-HE pts significantly improved on ICT (1st half 7.1 vs. 6.2, 2nd half,p<0.0001), HE pts did not show learning capability (1st half 7.9 vs 7.8, p=0.1). Retesting visit: All pts were retested a median of 20 days later without change in cirrhosis severity/ complications. Again HE pts did not show ICT learning (7.8 vs 6.9,p=0.37) while no-HE ones continued to improve (6.0 vs. 5.4, p<0.0001). Changes in tests over time: There was a significant improvement in four PHES subtests in the second testing compared to the first in no-HE pts (NC-A 42 vs 36, p=0.05, NC-B 103 vs 93, p=0.007, DS 46 vs 49,p=0.002, SD: 68 vs 64, p=0.05) and ICT lures (13 vs 11, p=0.05) in no-HE pts. In contrast there was only improvement in two of the 6 PHES subtests (NC-B 146 vs 131, p=0.34, SD: 90 vs 84, p=0.1, LTTt 132 vs 125,p=0.4, LTTe 49 vs 51, p=0.72), apart from DS (37 vs 41, p=0.001) & NC-A,( 56 vs 47, p=0.