Abstract：
BACKGROUND: Dementia and hepatic encephalopathy (HE) have symptom overlap and are challenging to differentiate. The presence of undiagnosed cirrhosis may lead to missed opportunities to treat HE, which was found in a Veterans database. This needs validation in a non-Veteran cohort.
METHODS: A retrospective cohort study was conducted between 2009 and 2019 using national non-Veteran patient data from the multi-center TriNetX database. Participants included 68,807 patients with a dementia diagnosis at ≥2 visits, no prior diagnosis of cirrhosis, and with sufficient laboratory test results to calculate the Fibrosis-4 (FIB-4) index, which indicates liver disease. Prevalences of high FIB-4 scores (>2.67 and >3.25) were measured within the cohort, and associations between high FIB-4 and comorbidities/demographics were examined.
RESULTS: Within the cohort (44.7% male, 78.0% white, mean age 72.73 years (±11.09)), 7.6% (n = 5815) had a FIB-4 index >3.25 and 12.8% (n=8683) had FIB-4 >2.67. In multivariable logistic regression models, FIB-4 > 3.25 was associated with male gender (OR: 1.42 [1.33-1.51]), congestive heart failure (OR:1.73 [1.59-1.87]), viral hepatitis (OR: 2.23 [1.84-2.68]), alcohol use disorder (OR: 1.39 [1.22-1.58]), and chronic kidney disease (OR: 1.38 [1.28-1.48]), and inversely associated with white race (OR: 0.76 [0.71-0.82]) and diabetes (OR: 0.82 [0.77-0.88]). Similar findings were associated with the FIB-4 > 2.67 threshold.
CONCLUSIONS: The findings of this national cohort suggest that the FIB-4 index could be utilized to screen for potential undiagnosed cirrhosis in patients with dementia and that hepatic encephalopathy that might be misdiagnosed as dementia or cause worsening of cognitive function in patients with dementia.
METHODS: A retrospective cohort study was conducted between 2009 and 2019 using national non-Veteran patient data from the multi-center TriNetX database. Participants included 68,807 patients with a dementia diagnosis at ≥2 visits, no prior diagnosis of cirrhosis, and with sufficient laboratory test results to calculate the Fibrosis-4 (FIB-4) index, which indicates liver disease. Prevalences of high FIB-4 scores (>2.67 and >3.25) were measured within the cohort, and associations between high FIB-4 and comorbidities/demographics were examined.
RESULTS: Within the cohort (44.7% male, 78.0% white, mean age 72.73 years (±11.09)), 7.6% (n = 5815) had a FIB-4 index >3.25 and 12.8% (n=8683) had FIB-4 >2.67. In multivariable logistic regression models, FIB-4 > 3.25 was associated with male gender (OR: 1.42 [1.33-1.51]), congestive heart failure (OR:1.73 [1.59-1.87]), viral hepatitis (OR: 2.23 [1.84-2.68]), alcohol use disorder (OR: 1.39 [1.22-1.58]), and chronic kidney disease (OR: 1.38 [1.28-1.48]), and inversely associated with white race (OR: 0.76 [0.71-0.82]) and diabetes (OR: 0.82 [0.77-0.88]). Similar findings were associated with the FIB-4 > 2.67 threshold.
CONCLUSIONS: The findings of this national cohort suggest that the FIB-4 index could be utilized to screen for potential undiagnosed cirrhosis in patients with dementia and that hepatic encephalopathy that might be misdiagnosed as dementia or cause worsening of cognitive function in patients with dementia.
摘要：
背景：痴呆和肝性脑病（HE）有症状重叠，难以区分。未确诊的肝硬化的存在可能导致错过治疗HE的机会，在退伍军人数据库中找到的.这需要在非退伍军人队列中进行验证。
方法：在2009年至2019年期间，使用来自多中心TriNetX数据库的国家非退伍军人患者数据进行了一项回顾性队列研究。参与者包括68,807名痴呆诊断≥2次就诊的患者，事先没有肝硬化的诊断,并有足够的实验室测试结果来计算纤维化-4（FIB-4）指数，这表明肝脏疾病。在队列中测量高FIB-4评分（>2.67和>3.25）的患病率，并检查了高FIB-4与合并症/人口统计学之间的关联。
结果：在队列中（男性占44.7％，78.0%白色,平均年龄72.73岁（±11.09）），7.6%(n=5815)的FIB-4指数>3.25,12.8%(n=8683)的FIB-4指数>2.67。在多变量逻辑回归模型中，FIB-4>3.25与男性相关（OR：1.42[1.33-1.51]），充血性心力衰竭（OR：1.73[1.59-1.87]），病毒性肝炎（OR：2.23[1.84-2.68]），酒精使用障碍（OR：1.39[1.22-1.58]），和慢性肾脏疾病（OR：1.38[1.28-1.48]），与白种人(OR:0.76[0.71-0.82])和糖尿病(OR:0.82[0.77-0.88])呈负相关。类似的发现与FIB-4>2.67阈值相关。
结论：本国家队列研究的结果表明，FIB-4指数可用于筛查痴呆患者潜在的未确诊肝硬化和可能被误诊为痴呆或导致痴呆患者认知功能恶化的肝性脑病。
方法：在2009年至2019年期间，使用来自多中心TriNetX数据库的国家非退伍军人患者数据进行了一项回顾性队列研究。参与者包括68,807名痴呆诊断≥2次就诊的患者，事先没有肝硬化的诊断,并有足够的实验室测试结果来计算纤维化-4（FIB-4）指数，这表明肝脏疾病。在队列中测量高FIB-4评分（>2.67和>3.25）的患病率，并检查了高FIB-4与合并症/人口统计学之间的关联。
结果：在队列中（男性占44.7％，78.0%白色,平均年龄72.73岁（±11.09）），7.6%(n=5815)的FIB-4指数>3.25,12.8%(n=8683)的FIB-4指数>2.67。在多变量逻辑回归模型中，FIB-4>3.25与男性相关（OR：1.42[1.33-1.51]），充血性心力衰竭（OR：1.73[1.59-1.87]），病毒性肝炎（OR：2.23[1.84-2.68]），酒精使用障碍（OR：1.39[1.22-1.58]），和慢性肾脏疾病（OR：1.38[1.28-1.48]），与白种人(OR:0.76[0.71-0.82])和糖尿病(OR:0.82[0.77-0.88])呈负相关。类似的发现与FIB-4>2.67阈值相关。
结论：本国家队列研究的结果表明，FIB-4指数可用于筛查痴呆患者潜在的未确诊肝硬化和可能被误诊为痴呆或导致痴呆患者认知功能恶化的肝性脑病。
