Minimal Hepatic Encephalopathy: The Reality Beyond Our Eyes

Abstract

RESUMOIntrodução: A encefalopatia hepática mínima define-se como um défice neurocognitivo ligeiro, não detectável ao exame clínico, que pode estar presente nos doentes cirróticos. Objectivo: Determinar a prevalência da encefalopatia hepática mínima num hospital prestador de cuidados de saúde secundários no Norte de Portugal. Material e Métodos: Realizou-se um estudo transversal em que foram incluídos os doentes cirróticos seguidos na consulta externa. Critérios de exclusão: encefalopatia hepática clínica, iliteracia, consumo activo de álcool e terapêutica com fármacos psicotrópicos ou lactulose. A presença de encefalopatia hepática mínima foi definida como um valor ≤ -4 na Pontuação Psicométrica da Encefalopatia Hepática, calculado de acordo com as normas portuguesas. Analisaram-se as variáveis: etiologia e gravidade da doença hepática e concentração da amónia sanguínea venosa. Considerou-se o valor de p < 0,05 como significativo. Resultados: Dos 102 doentes avaliados, 41 foram incluídos: 31 homens, idade média de 57 ± 10 anos, escolaridade média de 5 ± 2 anos, 31 Child-Pugh classe A, score MELD médio de 6 ± 3. Foi diagnosticada encefalopatia hepática mínima em 14 (34%) doentes. A presença de encefalopatia hepática mínima não se relacionou com a gravidade da doença hepática. Apesar de mais elevado, o valor médio da concentração da amónia venosa nos doentes com encefalopatia hepática mínima não foi significativamente diferente do valor médio da concentração da amónia venosa nos doentes sem encefalopatia hepática mínima (48,5 ± 13,3 vs. 45,6 ± 15,6 µmol/L, p = 0,555). Discussão: A prevalência da encefalopatia hepática mínima descrita está de acordo com os dados internacionais. Conclusão: A encefalopatia hepática mínima é uma entidade frequente que está presente precocemente na história natural da cirrose, mesmo em doentes compensados. Consequentemente, esta condição escondida deve ser activamente procurada e os doentes devidamente orientados após o diagnóstico. Palavras-chave: Cirrose Hepática; Encefalopatia Hepática; Psicometria; Testes Neuropsicológicos. ABSTRACT Introduction:Minimal hepatic encephalopathy refers to a mild neurocognitive impairment not detectable by clinical examination that can be present in cirrhotic patients. Aim: To determine the prevalence of minimal hepatic encephalopathy in a secondary healthcare center in Northern Portugal. Material and Methods: A cross-sectional study was conducted. Cirrhotic outpatients were included. Exclusion criteria: overt hepatic encephalopathy, illiteracy, active alcohol consumption, psychotropic drug use and therapy with lactulose. The presence of minimal hepatic encephalopathy was defined as a value ≤ -4 on the Psychometric Hepatic Encephalopathy Score, calculated according to the Portuguese norms. Variables analyzed: etiology and severity of liver disease and venous blood ammonia concentration. p values < 0.05 were considered significant. Results: From the 102 patients who were evaluated, 41 were included: 31 males, mean age 57 ± 10 years, mean education 5 ± 2...

Hepatic Encephalopathy; Prevalence, Precipitating Factors and Challenges of Management in a Resource-Limited Setting

“…The precipitants encountered in the current study were constipation, hypokalemia due to the use of diuretics, CNS drugs like benzodiazepines, infections and Upper GI bleeding which were in line with other studies [5,11]. In contrast blood transfusion and renal failure were the new entities observed in our study as precipitants.…”

“…This could partly be explained due to high prevalence of viral hepatitis B infection in the younger adults which is among the commonest causes of acute and chronic liver failure to both the general and health care worker populations in Tanzania [12,13]. The male predominant population in this study is likely due to the risk of chronic alcohol use as a cause of liver disease which was consistent with other studies [11].…”

“…Majority of patients found to have H.E were in their 3 rd and 4 th decades of life, which is younger as compared to other studies were most patients were in their 5 th decades of life [11]. This could partly be explained due to high prevalence of viral hepatitis B infection in the younger adults which is among the commonest causes of acute and chronic liver failure to both the general and health care worker populations in Tanzania [12,13].…”

Prevalence of minimal hepatic encephalopathy among patients with chronic liver disease in Ilorin, Nigeria

“…The prevalence of MHE in this study was comparable to the 41.0% reported by Praveen et al, 21 in Saudi Arabia, where more sophisticated diagnostic tools such as P300 auditory event potential (P300ERP) and critical flicker frequency (CFF) with psychometry were used to diagnose MHE. The prevalence of MHE in this study was higher than the 32.7% reported by Maldonado-Garja et al 22 in Mexico, and 34.0% reported by Barbosa et al 23 in Portugal.…”

Detection of Minimal Hepatic Encephalopathy in Iranian Patients with Cirrhosis

“…The areas with impairments in patients with MHE are attention, visuospatial perception, speed of information processing, especially in the psychomotor area, fine motor skills, and short-term memory. 5,6…”