Prevalence of and Factors Associated With Minimal Hepatic Encephalopathy in Patients With Cirrhosis of Liver

Abstract

Background/objectives: Minimal hepatic encephalopathy (MHE), though highly prevalent, is a frequently underdiagnosed complication of cirrhosis of the liver. Because lack of time is reported as the major reason for non-testing, identifying patients at high risk of MHE would help in targeting them for screening. We aimed to determine the factors associated with MHE to help identify patient subgroups with a higher risk of MHE for targeted screening.

Methods: Patients with cirrhosis of liver presenting between April 2015 and November 2016 were included. Those with a Psychometric Hepatic Encephalopathy Score (PHES) of ≤-5 points on psychometric testing were diagnosed to have MHE. Various demographic, clinical and laboratory parameters were included in a univariate and later multiple logistic regression models.

Results: Of the 180 (male = 166, 92.2%) patients included 94 (52.2%) had MHE. Though serum albumin, serum total bilirubin, serum aspartate aminotransferase, international normalized ration, Child-Turcotte-Pugh and Model-For-End-Stage-Liver-Disease scores were significant on univariate analysis, only CTP score was found to be significantly associated with MHE (P = 0.002) on multivariate analysis. A higher CTP class was associated with a higher risk of the presence of MHE. The Odds ratio for having MHE was higher with CTP classes of B (P ≤ 0.001) and C (P ≤ 0.001) compared to class A.

Conclusions: MHE is a common complication in patients with cirrhosis of liver and higher CTP scores independently predict the presence of MHE. Patients with CTP class B and C have a higher risk of suffering from MHE than CTP class A. Screening of patients in CTP class B and C is likely to increase the MHE detection rates while saving time, although select CTP class A patients may also need screening in view of public safety or poor quality of life.

Keywords: AASLD, The American Association for Study of Liver disease; ALT, alanine transaminase; AST, aspartate transaminase; C.I., confidence interval; CTP, Child Turcotte Pugh; Child Turcotte Pugh score; DST, digit symbol test; FCT, figure connection test; HE, hepatic encephalopathy; HRQOL, health-related quality of life; INR, international normalized ratio; ISHEN, International Society For Hepatic Encephalopathy and Nitrogen Metabolism; K+, potassium; Ltt, line tracing test; MELD, Model For End-Stage Liver Disease; MHE, minimal hepatic encephalopathy; NCT, number connection test; Na+, sodium; OR, odds ratio; PHES, psychometric hepatic encephalopathy score; Q1,Q3, quartile 1 and quartile 3; SD, standard deviation; SDT, serial dotting test; SPSS, Statistics Package for Social Sciences; TIPS, transjugular intrahepatic portosystemic shunt; WBC, white blood cells; cirrhosis of liver hepatic encephalopathy; psychometric hepatic encephalopathy score.