In:
Journal of Clinical Gastroenterology, Ovid Technologies (Wolters Kluwer Health), Vol. 56, No. 1 ( 2022-01), p. e11-e19
Abstract:
Acute-on-chronic liver failure (ACLF) is associated with high short-term mortality in those with hepatic encephalopathy (HE). Polyethylene glycol (PEG) 3350 electrolyte solution can ensure rapid gut catharsis, which may resolve HE more effectively than lactulose. In this open-label–randomized trial, we compared PEG+lactulose versus lactulose alone in ACLF with HE grade ≥2 for efficacy and outcome. Patients and Methods: Patients were randomized to receive PEG (2 L q12 h) followed by lactulose (30 mL q8 h) or standard medical treatment [SMT, lactulose (titrated 30 mL q8 h)]. Endpoints were HE grade improvement at 24 hours, 48 hours, and 7 days using hepatic encephalopathy scoring algorithm (HESA), ammonia reduction, HE resolution, and survival benefit. Results: Of 60 patients, 29 were randomized to PEG+lactulose arm and 31 to SMT. In the PEG arm, early reduction in HESA score was noted in more persons [18 (62.1%) vs. 10 (32.2%); P =0.021] with a shorter median time to HE resolution [4.5 (3 to 9) d vs. 9 (8 to 11) d; P =0.023]. On multivariate analysis, age [hazard ratio (HR),1.06 (1.00 to 1.13); P =0.03], HESA score [HR, 6.01 (1.27 to 28.5); P =0.024], and model for end-stage liver disease [HR, 1.26 (1.01 to 1.53); P =0.022] were predictors of mortality at 28 days. Ammonia level or reduction did not correlate with HE grades. Adverse events included excessive diarrhea (20.6% vs. 9.6%) in the PEG and SMT arms, albeit without dyselectrolytemia or worsened renal function. In the PEG versus SMT arm, survival at 28 days were 93.1% versus 67.7% ( P =0.010) and at 90 days was 68.9% versus 48.3% ( P =0.940), respectively, with fewer persons relapsing with HE in the PEG arm. Conclusions: PEG resulted in early and sustained HE resolution with improved short-term survival making, it a suitable and safe drug in patients with acute HE in ACLF.
Type of Medium:
Online Resource
ISSN:
0192-0790
DOI:
10.1097/MCG.0000000000001450
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2022
detail.hit.zdb_id:
2041558-8
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