Long-Term Effects of Rifaximin on Patients with Hepatic Encephalopathy: Its Possible Effects on the Improvement in the Blood Ammonia Concentration Levels, Hepatic Spare Ability and Refractory Ascites
Abstract
:1. Introduction
2. Materials and Methods
2.1. Statistical Analyses
2.2. Ethical Statement
3. Results
3.1. Clinical Characteristics of the Study Population
3.2. Long-Term Effects of Administration of RFX on Hyperammonemia and HE
3.3. Secondary Therapeutic Effects
3.4. Adverse Events
3.5. Relationship between RFX Administration and the RAAS
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Number of Patients | 112 |
---|---|
Sex (male/female) | 75/37 |
Age (in years, expressed as mean ± SD) | 65.1 ± 11.6 |
Etiology | |
Alcohol consumption | 47 (42.0%) |
Viral hepatitis | 27 (24.1%) |
NASH | 14 (12.5%) |
Alcohol consumption and viral hepatitis | 7 (6.3%) |
Alcohol consumption and autoimmune hepatitis | 1 (0.9%) |
Others | 16 (14.3%) |
Child–Pugh classification | |
Class A | 6 (5.4%) |
Class B | 56 (50.0%) |
Class C | 50 (44.6%) |
Child–Pugh score (mean ± SD) | 9.54 ± 2.1 |
MELD score | 12.9 ± 4.43 |
MELD sodium score | 13.4 ± 4.98 |
Blood ammonia concentration, NH3 (μg/dL) (mean ± SD) | 117.0 ± 61.3 |
Prothrombin time, PT (%) (mean ± SD) | 59.4 ± 15.3 |
Prothrombin time-international normalized ratio, PT-INR (mean ± SD) | 1.36 ± 0.23 |
Serum albumin concentration, Alb (g/dL) (mean ± SD) | 2.87 ± 0.57 |
Total-bilirubin, T-bil (mg/dL) (mean ± SD) | 3.30 ± 0.45 |
Blood urea nitrogen, BUN (mg/dL) (mean ± SD) | 16.3 ± 6.82 |
Serum creatinine concentration, Cr (mg/dL) (mean ± SD) | 0.94 ± 0.69 |
Estimated glomerular filtration rate, eGFR (mL/min/1.73 m2) (mean ± SD) | 69.6 ± 23.4 |
Serum sodium concentration, Na (mEq/L) (mean ± SD) | 139.2 ± 3.04 |
West-Haven grade | |
Minimal or I | 50 (44.6%) |
II | 38 (33.9%) |
III | 22 (19.6%) |
IV | 2 (1.8%) |
HCC | |
Presence | 40 (35.7%) |
Absence | 72 (64.3%) |
History of HCC treatment | |
Presence | 42 (37.5%) |
Absence | 70 (62.5%) |
History of gastrointestinal variceal treatment | |
Presence | 59 (52.7%) |
Absence | 53 (47.3%) |
Administration of diuretics | |
Loop diuretics | 43 (38.4%) |
Anti-aldosterone diuretics | 56 (50.0%) |
Administration of NSBBs | 11 (9.8%) |
Pretreatment Drug | Number of Patients |
---|---|
Oral BCAA preparations | 78 |
Synthetic disaccharides | 47 |
Intestinal regulators and laxatives | 38 |
Carnitine preparations | 30 |
Zinc preparations | 10 |
Satisfactory Control n = 39 | Poor Control n = 42 | Univariate | Multivariate | |||
---|---|---|---|---|---|---|
HR 95% CI | p-Value | HR 95% CI | p-Value | |||
Sex | ||||||
Male | 27 | 30 | ||||
Female | 12 | 12 | 0.83 | |||
Age | 66.8 ± 1.9 | 64.1 ± 1.8 | 0.32 | |||
Etiology | ||||||
Alcohol | 17 | 27 | ||||
Not alcohol | 22 | 15 | 0.06 | 0.40 | ||
CP score | 8.74 ± 0.30 | 9.90 ± 0.29 | 20.4 2.29–243 | <0.01 ** | 62.7 1.5–4526 | 0.028 * |
MELD score | 11.7 ± 0.69 | 13.3 ± 0.68 | 0.10 | 0.92 | ||
MELD sodium score | 12.1 ± 0.76 | 13.9 ± 0.74 | 0.10 | 0.83 | ||
NH3 | 123 ± 9.9 | 124 ± 9.5 | 0.96 | |||
Alb | 3.00 ± 0.08 | 2.85 ± 0.08 | 0.21 | |||
T-bil | 2.07 ± 0.67 | 3.59 ± 0.65 | 0.11 | 0.98 | ||
BUN | 15.8 ± 1.14 | 16.6 ± 1.11 | 0.65 | |||
Cr | 0.91 ± 0.10 | 0.90 ± 0.10 | 0.93 | |||
eGFR | 72.8 ± 3.48 | 66.9 ± 3.39 | 0.22 | |||
OHE | ||||||
Presence | 24 | 21 | ||||
Absence | 15 | 21 | 0.29 | |||
HCC | ||||||
Presence | 16 | 12 | ||||
Absence | 23 | 30 | 0.24 | |||
History of EGV treatment | ||||||
Presence | 18 | 26 | ||||
Absence | 21 | 16 | 0.16 | 0.13 | ||
Administration of anti-aldosterone diuretics | ||||||
Presence | 15 | 22 | ||||
Absence | 24 | 20 | 0.21 | |||
Renin | 40.9 ± 18.5 | 127.9 ± 17.8 | 26.6 3.46–551 | <0.01 ** | 48.4 4.6–1483 | <0.01 ** |
Aldosterone | 264.4 ± 89.8 | 307.2 ± 80.4 | 0.72 |
Renin Levels | Satisfactory Control | Poor Control |
---|---|---|
Less than 41 pg/mL | 32 | 14 |
41 pg/mL or higher | 7 | 28 |
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Yokoyama, K.; Fukuda, H.; Yamauchi, R.; Higashi, M.; Miyayama, T.; Higashi, T.; Uchida, Y.; Shibata, K.; Tsuchiya, N.; Fukunaga, A.; et al. Long-Term Effects of Rifaximin on Patients with Hepatic Encephalopathy: Its Possible Effects on the Improvement in the Blood Ammonia Concentration Levels, Hepatic Spare Ability and Refractory Ascites. Medicina 2022, 58, 1276. https://doi.org/10.3390/medicina58091276
Yokoyama K, Fukuda H, Yamauchi R, Higashi M, Miyayama T, Higashi T, Uchida Y, Shibata K, Tsuchiya N, Fukunaga A, et al. Long-Term Effects of Rifaximin on Patients with Hepatic Encephalopathy: Its Possible Effects on the Improvement in the Blood Ammonia Concentration Levels, Hepatic Spare Ability and Refractory Ascites. Medicina. 2022; 58(9):1276. https://doi.org/10.3390/medicina58091276
Chicago/Turabian StyleYokoyama, Keiji, Hiromi Fukuda, Ryo Yamauchi, Masashi Higashi, Takashi Miyayama, Tomotaka Higashi, Yotaro Uchida, Kumiko Shibata, Naoaki Tsuchiya, Atsushi Fukunaga, and et al. 2022. "Long-Term Effects of Rifaximin on Patients with Hepatic Encephalopathy: Its Possible Effects on the Improvement in the Blood Ammonia Concentration Levels, Hepatic Spare Ability and Refractory Ascites" Medicina 58, no. 9: 1276. https://doi.org/10.3390/medicina58091276