Undiagnosed Cirrhosis and Potential Hepatic Encephalopathy in a National Cohort Of Patients with Dementia

Scott Silvey,Richard Sterling, Evan French, Michael Godschalk, Angela Gentili, Nilang Patel,Jasmohan Bajaj

crossref(2024)

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摘要
Abstract Dementia and hepatic encephalopathy (HE) have symptom overlap and are challenging to differentiate. The presence of undiagnosed cirrhosis in dementia patients may lead to missed opportunities to treat HE, which was found in a Veterans database, which needs validation. A retrospective cohort study was conducted between 2009 and 2019 using national non-Veteran patient data from the TriNetX database. Participants included 68,807 patients with a diagnosis of dementia at ≥2 visits, no prior diagnosis of cirrhosis, and with sufficient laboratory test results to calculate the Fibrosis-4 (FIB-4) index. Rates of high FIB-4 scores (>2.67 and >3.25) were measured within the cohort, and associations between high FIB-4 and comorbidities/demographics were examined. Within the cohort (44.7% male, 78.0% white, mean age 72.73 years (± 11.09)). 7.6% (n = 5815) had a FIB-4 index >3.25 and 12.8% (n = 8683) had FIB-4 >2.67. In multivariable logistic regression models, FIB-4 > 3.25 was associated with male gender (OR: 1.42 [1.33 – 1.51]), congestive heart failure (OR:1.73 [1.59 – 1.87]), viral hepatitis (OR: 2.23 [1.84 – 2.68]), alcohol use disorder (OR: 1.39 [1.22 – 1.58]), and chronic kidney disease (OR: 1.38 [1.28 – 1.48]), and inversely associated with white race (OR: 0.76 [0.71 – 0.82]) and diabetes (OR: 0.82 [0.77 – 0.88]). Similar findings were associated with the FIB-4 > 2.67 threshold. The findings of this national cohort suggest that the FIB-4 index should be utilized to screen for potential undiagnosed cirrhosis in patients with dementia and that HE that might be misdiagnosed as dementia or cause worsening of cognitive function in patients with dementia.
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