Bristol Stool Scale as a Determinant of Hepatic Encephalopathy Management in Patients With Cirrhosis

被引:12
|
作者
Duong, Nikki K. [1 ,2 ]
Shrestha, Shreesh [1 ,2 ]
Park, Dan [1 ,2 ]
Shahab, Omer [1 ,2 ]
Fagan, Andrew [1 ,2 ]
Malpaya, Zenaida [1 ,2 ]
Gallagher, Mary L. [1 ,2 ]
Morris, April [1 ,2 ]
Davis, Brian C. [1 ,2 ]
Bajaj, Jasmohan S. [1 ,2 ]
机构
[1] Virginia Commonwealth Univ, Richmond, VA 23284 USA
[2] Cent Virginia Vet Healthcare Syst, Richmond, VA 23249 USA
来源
AMERICAN JOURNAL OF GASTROENTEROLOGY | 2022年 / 117卷 / 02期
关键词
FORM SCALE; LACTULOSE;
D O I
10.14309/ajg.0000000000001550
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
INTRODUCTION: Bowel movement (BM) frequency is used to titrate lactulose for hepatic encephalopathy (HE). However, stool consistency using the Bristol stool scale (BSS, 0-7) is often ignored. METHODS: The study included pre-BSS and post-BSS cohorts. BSS was incorporated into decision-making after training in outpatients with cirrhosis. Two to 3 BMs/d and BSS 3-4 were considered normal, whereas the rest were considered high or low; concordance between the metrics was evaluated. Medication changes and 6-month admissions were compared between this group (post-BSS) and a comparable previous group (pre-BSS). Concordance and regression analyses for all-cause admissions and H E-related admissions were performed, and comparisons were made for HE-related medication stability. In the longitudinal analysis, an outpatient group seen twice was analyzed for BSS and BMs. RESULTS: In the post-BSS cohort, 112 patients were included with only 46% BSS and BMs concordance and modest BSS/BMs correlation (r = 0.27, P = 0.005). Compared with a pre-BSS cohort (N = 114), there was a lower 6-month total (4% vs 0.36%, P< 0.001) or HE-related admission (1% vs 0.12%, P= 0.002). Regression showed model for end-stage liver disease (odds ratio [OR]: 1.10, P= 0.003) and pre-BSS/post-BSS (OR: 0.04, P< 0.001) for all-cause admissions and HE (OR: 3.59, P= 0.04) and preera/postera (OR: 0.16, P = 0.02) for HE-related admissions as significant. HE medication regimens were more stable post-BSS vs pre-BSS (32% vs 20%, P = 0.04), which was due to patients with BSS > BMs (P= 0.02). In the longitudinal analysis, 33 patients without medication changes or underlying clinical status changes were tested 36 +/- 24 days apart. No changes in BSS (P = 0.73) or BMs (P = 0.19) were found. DISCUSSION: BSS is complementary and additive to BM frequency, can modulate the risk of readmissions and stabilize HE-related therapy changes in outpatients with cirrhosis, and could help personalize HE management.
引用
收藏
页码:295 / 300
页数:6
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