Simple scoring model for predicting overt hepatic encephalopathy in geriatric cirrhosis: A multicenter retrospective cohort study

Identifying the risk of overt hepatic encephalopathy (OHE) in geriatric patients with cirrhosis remains challenging. This study aimed to investigate the independent factors for OHE development in geriatric cirrhosis and to establish a simple scoring model to identify individuals at risk for OHE. We conducted a retrospective review of geriatric patients with cirrhosis aged ≥ 80 years who were admitted between April 2006 and November 2022. Baseline parameters were assessed at the time of admission, and factors associated with OHE development were examined using Fine-Gray proportional hazards regression analysis, with mortality as a competing risk. Based on the factors associated with OHE development, a simple hepatic encephalopathy (sHE) score was calculated, and its efficacy was subsequently verified. Of the 270 patients analyzed, the median age was 83 years, and 63% were male. During a median follow-up of 1.8 years, 41 (15%) patients developed OHE and 120 (44%) patients died. Multivariable analysis revealed that serum albumin (sub-distribution hazard ratio [SHR], 0.51; 95% confidence interval [CI], 0.27-0.98; p = 0.042) and ammonia (SHR, 1.01; 95% CI, 1.00-1.02; p = 0.006) levels were independent factors for OHE development in geriatric cirrhosis. Based on the sHE score, the high-risk and intermediate-risk groups exhibited a high incidence of OHE, whereas those in the low-risk group rarely developed OHE. Serum albumin and ammonia levels were identified as independent risk factors for the development of OHE in geriatric cirrhosis. The sHE score was useful for stratifying the risk of OHE in the geriatric population.