Routine Cirrhosis screening in dementia patients may rule out hepatic encephalopathy: JAMA

A recent retrospective cohort study revealed that veterans with dementia may be at risk of undiagnosed cirrhosis that can potentially lead to missed opportunities for treating Hepatic Encephalopathy (HE). The findings were published in the Journal of American Medical Association.

This study utilized data from the Veterans Health Administration (VHA) and two separate validation cohorts from 2009 and 2019 to highlight the prevalence and risk factors associated with undiagnosed cirrhosis among this vulnerable population. The cohort consisted of a total of 177,422 US veterans who were diagnosed with dementia during at least two clinic visits, without a prior cirrhosis diagnosis and with sufficient laboratory test results to calculate the Fibrosis-4 (FIB-4) score. Among these veterans, 5.3% expressed an FIB-4 score greater than 3.25 which suggested cirrhosis, while 10.3% had a score greater than 2.67 which indicated advanced fibrosis.

The key findings of the study were;

The outcome identified several major risk factors including older age, male gender, congestive heart failure, viral hepatitis, high Alcohol Use Disorders Identification Test scores and chronic kidney disease which were associated with a higher FIB-4 score. White race, diabetes, hyperlipidemia, stroke, tobacco use disorder and rural residence were inversely linked with the elevated FIB-4 scores.

Also, the implications of undiagnosed cirrhosis in dementia patients may contribute to the development of Hepatic Encephalopathy, which is often challenging to distinguish from dementia. The outcomes emphasize the importance of screening for cirrhosis using the FIB-4 score in patients with dementia to uncover reversible factors linked to cognitive impairment to enhance patient outcomes. Local validation cohorts further confirmed the association between high FIB-4 scores and cirrhosis. 

Source:

Bajaj, J. S., Silvey, S. G., Rogal, S., O’Leary, J. G., Patton, H., Morgan, T. R., Kanagalingam, G., Gentili, A., Godschalk, M., & Patel, N. (2024). Undiagnosed cirrhosis and hepatic encephalopathy in a national cohort of veterans with dementia. JAMA Network Open, 7(1), e2353965. https://doi.org/10.1001/jamanetworkopen.2023.53965