Prevalence and prognostic value of quantified electroencephalogram (EEG) alterations in cirrhotic patients

• Published in: Journal of hepatology Vol. 35; no. 1; pp. 37 - 45
• Main Authors: Amodio, Piero, Del Piccolo, Franco, Pettenò, Elena, Mapelli, Daniela, Angeli, Paolo, Iemmolo, Rosamaria, Muraca, Maurizio, Musto, Carmine, Gerunda, Giorgio, Rizzo, Cristiano, Merkel, Carlo, Gatta, Angelo
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier B.V 01.07.2001; Elsevier
• Subjects: Aged; Biological and medical sciences; Cirrhosis; Electroencephalogram; Electroencephalography; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Hepatic encephalopathy; Hepatic Encephalopathy - etiology; Humans; Liver Cirrhosis - complications; Liver Cirrhosis - mortality; Liver Cirrhosis - physiopathology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Odds Ratio; Other diseases. Semiology; Prognosis; Proportional Hazards Models; Severity of Illness Index; Spectral electroencephalogram analysis; Survival; Cirrhosis; Electroencephalogram; Spectral electroencephalogram analysis; SBP, spontaneous bacterial peritonitis; Survival; AST, aspartate amino-transferase; Hepatic encephalopathy; MDF, mean dominant frequency of EEG tracing; Human; Nervous system diseases; Prognosis; Liver; Hepatic disease; Electroencephalography; Statistical study; Cerebral disorder; Electrodiagnosis; Encephalopathy; Central nervous system disease; Digestive diseases; Complication; Predictive factor
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/S0168-8278(01)00129-5

Background/Aims : The electroencephalogram (EEG) is frequently altered in cirrhotic patients. We, therefore, performed a study to ascertain the features and the prognosis of cirrhotic patients without current overt hepatic encephalopathy (OHE) who have EEG alterations. Methods : A series of 296 consecutive cirrhotic patients who had undergone quantified-EEG was studied. The median follow-up was 442 days, 128 patients had bouts of OHE and 78 patients died from liver-related causes. Another group of 124 cirrhotic patients with a median follow-up of 223 days was examined to validate the prognostic model. Results : EEG alterations were detected in 38% of the patients. The prevalence of EEG alterations was associated with the severity of cirrhosis (class B: odds ratio (OR)=2.3, 95% confidence interval (CI)=1.2–4.7; class C: OR=3.5, 95% CI=1.6–7.7), but not with the aetiology (alcoholic vs. non-alcoholic: OR=0.9; 95% CI=0.5–1.5). The EEG predicted the occurrence of OHE ( χ 2 =26; P <0.001) and mortality ( χ 2 =34; P <0.001), also adjusting for Child–Pugh class by a multivariate analysis. In the patients with a Child–Pugh score of ≥8, the EEG discriminated between those patients with a higher 1-year risk of OHE (hazard ratio (HR)=3.3, 95% CI=1.8–6.1) and death (HR=3.1, 95% CI=1.7–5.6). Conclusions : In conclusion, quantified-EEG had a prognostic value for the occurrence of bouts of OHE and mortality in cirrhotic patients.