Impact of thiamine (vitamin B1) supplementation on hepatic encephalopathy and mortality in patients with decompensated alcoholic liver cirrhosis

Background Malnutrition and cognitive impairment are common complications in patients with decompensated alcoholic liver cirrhosis (LC). Therefore, some guidelines recommend thiamine substitution in these patients. However, little is known about its effect on hepatic encephalopathy (HE) or other liver-related complications. We evaluated the frequency of thiamine supplementation in patients with decompensated alcoholic LC and its impact on HE development and transplant-free survival.

Methods We retrospectively investigated 289 patients with decompensated alcoholic LC who were admitted to our hospital between 2011 and 2023 with at least one follow up in our clinic. Medication at discharge was screened for thiamine-containing supplements. Time to first HE and transplant-free survival was examined during 90 days after discharge.

Results A number of 139 (48.1%) patients received daily thiamine-containing supplements, most frequent was intake of vitamin-B-complex (52.5%) or single vitamin-B1 (47.5%). Less patients (8.6%) took multivitamin-supplementation. No significant differences regarding sex, MELD, HE at baseline and intake of HE-prophylaxis between patients with and without thiamine-supplementation were observed.

Overall, 69 patients developed HE, 24 died and six received LTx. Multivariable Cox regression analysis adjusted for MELD, age and sex indicates no difference regarding transplant-free survival between groups (HR=0.91; p=0.80). Furthermore, Competing Risk analysis, additionally adjusted for HE at baseline and intake of HE-prophylaxis, shows no significant difference between groups concerning risk of HE development (HR=0.87; p=0.56).

Conclusion As thiamine does not ameliorate risk of HE development or death in decompensated cirrhosis, further studies are needed to reflect benefits and possible risks, e.g. polypharmacy, of broad vitamin-B application.

Publication History

Article published online:
23 January 2024