Tu2057 – Glucocorticoids Decrease Apoptosis and Autophagy of Hepatocytes Via Pi3K/Akt/Mtor Signaling Pathway in Autoimmune Hepatitis

Background: Hepatic encephalopathy affects approximately 30-40 % of patients with cirrhosis with higher incidence in decompensated patients.It remains a burden on the health care system despite the advances in the care of patients with cirrhosis.CT of the head (CTH) is commonly performed for patients with hepatic encephalopathy with some studies showing low yield of brain imaging.Aim: To determine the yield of CTH in cirrhotic patients with encephalopathy and identify clinical predictors for positive CTH.Method: This is a retrospective chart review of cirrhotic patients who underwent CTH for encephalopathy at a large volume liver transplant center from January to July 2018.Data collection was performed using the hospital electronic medical records.We defined findings in CTH that could explain encephalopathy (positive CTH) as acute cerebrovascular accidents, cerebral edema or intracranial mass lesions.We defined clinical indicator of neurological injuries (CINI) as the presence of focal neurologic signs, seizures, or history of fall/trauma.We conducted univariate and multivariate logistic regression models to identify predictors of positive CTH.Variable selection for the multivariate model was done using the corrected Akaike Information Criterion.Finally, we computed the diagnostic accuracy for the predictive variables.Results: 132 patients were included.Positive findings on CTH were observed in 14.4%.Baseline characteristics were similar between the two groups except for presence of CINI which was found in 63.2% of patients with positive CTH compared to 28.3% of patients with negative CTH (p-value<0.01).In our single center cohort, neither age, gender, platelets count, INR, presence of infections, advanced liver disease (including having TIPS), acute kidney injury, or receiving neuropsychological medications could predict having a positive or negative CTH.However, the presence of CINI was the only predictor of having a positive CTH.The presence of CINI has positive likelihood ratio (LR) of 2.2, negative LR 0.52, positive predictive value 27.3%, negative predictive value of 92%, specificity 71.7%, and sensitivity 63.2%.Conclusion: Many patients with hepatic encephalopathy undergo unnecessary CTH.Based on our single center cohort, clinical indicators of neurological injuries could predict positive CTH.The decision to obtain CTH should not be based on the presence of advanced liver disease, elevated INR or low platelets.