Year: 2017
Type: letter
Abstract: Potential conflict of interest: Nothing to report. We thank Dr. Zheng and colleagues for their interest in our study on the risk of hepatic encephalopathy in a population‐based cohort of American veterans.1 Zheng et al. indicated that our study included few Asians. Given that our model was comprised of markers of liver function (albumin and bilirubin) and clinically significant portal hypertension (use of nonselective beta‐blockers) but not race, we have little reason to suspect that the performance of this model will be different in Asians. Zheng et al. questioned whether the impact of statins is linked to obesity, which they posit to be more prevalent in American patients with cirrhosis. Available data suggest that the beneficial effect of statins in patients with portal hypertension is related to improvements in vascular endothelial function and decreased inflammatory response to gut bacteria and not to cholesterol‐lowering.1 Indeed, there are data that statins prevent decompensation in Asian patients with hepatitis B–related cirrhosis.2 Zheng et al. posit that hepatitis B may be associated with cognitive changes (which may not have been captured in our data set).3 To our knowledge, evidence to support an effect of hepatitis C virus (more prevalent in our cohort) on cognition and brain function is more robust.4 However, and more importantly, there are no data linking the cerebral effects of either hepatitis B or C virus to development of hepatic encephalopathy in patients with no cirrhosis or increased risk of hepatic encephalopathy in those with cirrhosis.
Source: Hepatology
DOI: 10.1002/hep.29746
Authors: Elliot B. Tapper, Anna S.‐F. Lok, Grace L. Su
Institution: University of Michigan
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4248093243