{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T16:06:46Z","timestamp":1785168406069,"version":"3.55.0"},"reference-count":41,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2019,4,29]],"date-time":"2019-04-29T00:00:00Z","timestamp":1556496000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["R21TR002024"],"award-info":[{"award-number":["R21TR002024"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011284","name":"Valeant Pharmaceuticals International","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011284","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006379","name":"Office of Research and Development","doi-asserted-by":"publisher","award":["I0CX001076"],"award-info":[{"award-number":["I0CX001076"]}],"id":[{"id":"10.13039\/100006379","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Hepatic encephalopathy (HE) can adversely affect outcomes in both in\u2010patients and out\u2010patients with cirrhosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To define targets for improving quality of care in HE management in the multi\u2010centre North American Consortium for End\u2010Stage Liver Disease (NACSELD) cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>NACSELD in\u2010patient cohort was analysed for (a) medication\u2010associated precipitants, (b) aspiration pneumonia development, (c) HE medication changes, and (d) 90\u2010day HE recurrence\/readmissions. Comparisons were made between patients on no\u2010therapy, lactulose only, rifaximin only or both. Ninety\u2010day HE\u2010readmission analysis was adjusted for MELD score.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Two thousand eight hundred and ten patients (1102 no\u2010therapy, 659 lactulose, 154 rifaximin, 859 both) were included. HE on admission, and HE rates during hospitalisation were highest in those on lactulose only or dual therapy compared to no\u2010therapy or rifaximin only (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). Medications were the most prevalent precipitants (32%; 21% lactulose over\/underuse, 5% benzodiazepines, 4% opioids, 1% rifaximin underuse, 1% hypnotics). Patients with medication\u2010associated precipitants had a better prognosis compared to other precipitants. A total of 23% (n\u00a0=\u00a0217) reached grade 3\/4 HE, of which 16% developed HE\u2010related aspiration pneumonia. Two thousand four hundred and twenty patients were discharged alive without liver transplant (790 no\u2010therapy, 639 lactulose, 136 rifaximin, 855 both); 12.5% (n\u00a0=\u00a099) of no\u2010therapy patients did not receive a discharge HE therapy renewal. Ninety\u2010day HE\u2010related readmissions were seen in 16% of patients (9% no\u2010therapy, 9% rifaximin only, lactulose only 18%, dual 21%, &lt;0.001), which persisted despite MELD adjustment (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.009).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Several targets to improve HE management were identified in a large cohort of hospitalised cirrhotic patients. Interventions to decrease medication\u2010precipitated HE, prevention of aspiration pneumonia, and optimisation of HE medications are warranted.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.15265","type":"journal-article","created":{"date-parts":[[2019,4,30]],"date-time":"2019-04-30T19:28:29Z","timestamp":1556652509000},"page":"1518-1527","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":56,"title":["Targets to improve quality of care for patients with hepatic encephalopathy: data from a multi\u2010centre cohort"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4928-3681","authenticated-orcid":false,"given":"Jasmohan S.","family":"Bajaj","sequence":"first","affiliation":[{"name":"Richmond Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline G.","family":"O\u2019Leary","sequence":"additional","affiliation":[{"name":"Dallas Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0486-0174","authenticated-orcid":false,"given":"Puneeta","family":"Tandon","sequence":"additional","affiliation":[{"name":"Edmonton AB Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Wong","sequence":"additional","affiliation":[{"name":"Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick S.","family":"Kamath","sequence":"additional","affiliation":[{"name":"Rochester Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott W.","family":"Biggins","sequence":"additional","affiliation":[{"name":"Seattle Washington"},{"name":"Colorado Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8371-4524","authenticated-orcid":false,"given":"Guadalupe","family":"Garcia\u2010Tsao","sequence":"additional","affiliation":[{"name":"West Haven Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Lai","sequence":"additional","affiliation":[{"name":"San Francisco California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael B.","family":"Fallon","sequence":"additional","affiliation":[{"name":"Phoenix Arizona"},{"name":"Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul J.","family":"Thuluvath","sequence":"additional","affiliation":[{"name":"Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo E.","family":"Vargas","sequence":"additional","affiliation":[{"name":"Scottsdale Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedict","family":"Maliakkal","sequence":"additional","affiliation":[{"name":"Memphis Tennessee"},{"name":"Rochester New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ram M.","family":"Subramanian","sequence":"additional","affiliation":[{"name":"Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leroy R.","family":"Thacker","sequence":"additional","affiliation":[{"name":"Richmond Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. 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