S2472 Dementia and Cirrhosis Overlap Associated With Increased Risk of Developing First Hepatic Encephalopathy Episode, Decompensation and Greater Mortality, Compared to Patients With Cirrhosis Without Dementia

Introduction: With the aging cirrhosis population, the potential overlap between dementia and HE is becoming increasingly significant and may influence the progression of cirrhosis. We aimed to determine the risk of the first HE episode in cirrhosis patients with dementia compared to those without dementia. Methods: The TriNetX Research Network with 98 healthcare organizations was queried to identify patients diagnosed with cirrhosis from 2010-19. The population was divided into 2 cohorts using validated codes: 1) patients diagnosed with dementia after cirrhosis diagnosis (cirrhosis + dementia) 2) patients without a dementia diagnosis (cirrhosis – dementia). Propensity score matching (PSM) was used to create cohorts balanced for co-variates. Outcomes including new HE, other decompensations, and death were assessed from 30 days to 5 years from index event. The risk of each outcome was reported as a percentage and compared using risk differences. Kaplan-Meier analyses were used to compare the probability of each outcome during the follow-up period; sensitivity analyses were performed between 6 months and 5 years. Results: A total of 781,979 patients were identified (45,526 cirrhosis + dementia and 736,453 cirrhosis–dementia). After PSM, 44,033 patients were included in each group. Overall, 29% of patients in the cirrhosis + dementia carried a diagnosis of HE at the end of the follow up period compared to 16% of the cirrhosis–dementia cohort (P < 0.001). Excluding those with HE prior to dementia, the risk of new HE was 13.3% in the cirrhosis + dementia compared to 11.5% in the cirrhosis–dementia cohort (risk difference 1.8%, 95% CI 1.2-2.3, P < 0.001). KM analysis revealed that patients with cirrhosis + dementia were more likely to be diagnosed with HE (log rank χ2 154.5 P < 0.001), and this persisted on sensitivity analysis from 6 months to 5 years (log rank χ2 117.836, P < 0.001). Cirrhosis + dementia was also associated with a higher probability of new ascites (log rank χ2 365.7, P < 0.001), new varices (log rank χ2 63.689, P < 0.001), and mortality (log rank χ2 302.3, P < 0.0001) from both 30-days and 6-months. Conclusion: We found that patients with cirrhosis + dementia are at higher risk of HE, decompensation and death. We also observed a notably higher rate of HE diagnosis at baseline in the patients diagnosed with dementia after cirrhosis diagnosis. Improving differentiation between dementia and HE symptoms and greater awareness among clinicians taking care of patients with cirrhosis is needed.