Anemia and hypoalbuminemia are associated with hepatic encephalopathy and mortality after portal hypertension-related bleeding

Abstract

Background/Objectives

Modifiable factors may influence prognosis in patients with cirrhosis and portal hypertension-related bleeding (PHB). This study characterized metabolic and hematological profiles during and after PHB and evaluated their impact on liver-related events and mortality.

Patients and methods

Observational, single-center, retrospective cohort study including patients with cirrhosis admitted for PHB and followed for 1 year. Epidemiological, clinical, analytical, and hemodynamic data were collected. Anemia was defined according to World Health Organization criteria, and the hypoalbuminemia threshold was established using receiver operating characteristic (ROC) curves and the Youden index. Risk factors for liver-related events and death were assessed using Cox regression and cumulative incidence functions with competing risks.

Results

Forty-eight patients were included (60.4% men; 35.5% alcohol-related cirrhosis), with a median age of 63 years (IQR 55–74). During one-year follow-up, hepatic encephalopathy (HE) was the most frequent liver-related event (21%). Hypoalbuminemia was independently associated with an increased risk of hepatic encephalopathy at 6 months (sHR 5.70, 95% CI 1.36–23.8, p = 0.017) and at 1 year (sHR 7.28, 95% CI 1.08–48.8, p = 0.041). One-year survival was significantly lower in patients with HE (60% vs. 100%, p < 0.001), hypoalbuminemia (60% vs. 96.7%, p = 0.005), and anemia (80% vs. 100%, p = 0.016). Patients receiving red blood cell transfusion during PHB showed better liver function at 1 year (median MELD 9 [IQR 7–10] vs. 10 [IQR 9.8–12.5], p = 0.017).

Conclusions

Anemia and hypoalbuminemia are potentially modifiable factors associated with increased risk of HE and mortality within 1 year after PHB. Whether correction of anemia and nutritional status improves prognosis remains to be determined.

Resumen

Introducción/Objetivos

Los factores modificables pueden influir en el pronóstico de los pacientes con cirrosis y hemorragia relacionada con hipertensión portal (PHB). Este estudio evaluó el impacto de los perfiles hematológicos y nutricionales sobre los eventos hepáticos y la mortalidad tras PHB.

Pacientes y métodos

Estudio observacional, retrospectivo y unicéntrico que incluyó pacientes con cirrosis ingresados por PHB y seguidos durante 1 año. Se recogieron datos epidemiológicos, clínicos, analíticos y hemodinámicos. La anemia se definió según criterios de la OMS y la hipoalbuminemia mediante curvas ROC e índice de Youden. Los factores de riesgo se analizaron mediante regresión de Cox y análisis de riesgos competitivos.

Resultados

Se incluyeron 48 pacientes (60,4% varones; mediana de edad 63 años [RIC 55–74]). Durante el seguimiento, la encefalopatía hepática (EH) fue el evento hepático más frecuente (21%). La hipoalbuminemia se asoció independientemente con EH a los 6 meses (HR 5,70; IC95% 1,36–23,8; p = 0,017) y al año (HR 7,28; IC95% 1,08–48,8; p = 0,041). La supervivencia al año fue menor en pacientes con EH (60% vs. 100%; p< 0,001), hipoalbuminemia (60% vs. 96,7%; p = 0,005) y anemia (80% vs. 100%; p = 0,016). Los pacientes transfundidos durante la PHB presentaron menor MELD al año (9 [RIC 7–10] vs. 10 [RIC 8,9–12,5]; p = 0,017).

Conclusiones

La anemia y la hipoalbuminemia se asocian con mayor riesgo de EH y mortalidad tras PHB. Debe evaluarse si la corrección de estas alteraciones mejora el pronóstico.