OBJECTIVES:

Hepatic encephalopathy (HE) is a spectrum of neurocognitive changes in cirrhotic patients. Particularly, overt hepatic encephalopathy (OHE) is associated with increased rates of hospitalizations and mortality. International guidelines recommend Lactulose and Rifaximin for the prevention of OHE recurrence.

The aim of this study was to assess adherence to guidelines for secondary prevention of OHE in clinical practice using Health Information Systems (HIS).

METHODS:

Retrospective observational study on claims database from Marche region (1.5 million of inhabitants) including patients discharged alive with primary or secondary hepatic encephalopathy (HE) diagnosis (ICD-9-CM 572.2, 070.22, 070.23, 070.42, 070.44, 070.49, 070.71) between 2010 and 2013. The first hospitalization was defined index-event.

Demographic characteristics and comorbidities were collected during the 12 months before the index-event.

Data on consumption of lactulose and rifaximin were collected for 1 years after index-event. Adherence to recommended drugs was evaluated using Medication Possession Ratios (MPR) and patients were stratified in: untreated, no-adherent (MPR<75%) and adherent (MPR≥75%).

Furthermore, the association between adherence and patients’ characteristics were assessed using Chi-square test and Fisher exact test when opportune.

RESULTS:

569 patients with a first HE hospitalization were selected, 385 of whom discharged alive and included in the study. Overall, 129 (33.5%) were untreated during the first year after the index-event, only 35 (9.1%) was adherent to lactulose and 16 (4.2%) to rifaximin.

Adherence was positively associated with presence of ascites (p-value <0.001), intra-abdominal venous shunt procedure (p-value 0.024) and use of Proton pump inhibitors (PPIs) (p-value <0.001), no association with age and gender were observed.

CONCLUSIONS:

The study provides Real World estimates of adherence to treatment in patients with OHE. The high proportion of untreated and no-adherent patients highlights the need of specific training for Health Professionals to improve patient’s management.