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

Bale, Abhijith; Pai, Girish K; Shetty, Surekha D; Balaraju, Girisha; Shetty, Anil

doi:10.1016/j.jceh.2017.06.005

Cited by 26 publications

(28 citation statements)

References 39 publications

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“…The high cut-off value in this study may be due to the younger age of the population, the fact that most of them came from urban areas and probably the socio-cultural difference compared to other countries. We found 34 cirrhotic patients with a PHES score less than − 3 points giving a 74% India [14,15]. This higher prevalence in our study could be explained by the age, the lower level of studies and the signs of decompensated cirrhosis which were more important in patients with MHE.…”

Section: Discussioncontrasting

confidence: 44%

“…When the two groups of cirrhotic patients with and without MHE was compared, MHE was found to be associated with age (p 0.001) and number of years of study (p 0.001). We didn't nd any correlation between gender, Child Pugh score, MELD score, reported Child score as the only variable associated with onset of MHE [14]. Li et al found that the higher the Child score, the higher the number of cases of MHE [9].…”

Section: Discussionmentioning

confidence: 62%

“…The cut-off between the normal and pathologic values of the PHES was set at -4 according to the lower boundary of the 95% range between + 2 and − 2 SD [1,7,9,[13][14]. In our study we considered the same methodology and we found that the lower limit was set at -3 points.…”

Section: Discussionmentioning

confidence: 99%

“…The mean results of NCT-A, NCT-B, SDT, DST, LTT tests were respectively 85. 14 [10].The few numbers of patients with cirrhosis included in these studies could be explained by the numerous exclusion criteria while the difference in mean ages could be explained by the difference in the aetiologies of cirrhosis which vary from one population to another.…”

Section: Discussionmentioning

confidence: 99%

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Normalization of the Psychometric Encephalopathy Score in Cameroonian Population

Djomatcho

Kowo

Ndam

et al. 2020

Preprint

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Background: Minimal hepatic encephalopathy (MHE) is the presence of neuropsychological abnormalities detectable by psychometric tests. Psychometric Hepatic Encephalopathy Score (PHES) is a gold standard test for the early diagnosis of MHE in cirrhotic patients. Aim: To standardize the PHES in a healthy Cameroonian population and to evaluate the prevalence of MHE among cirrhotic patients. Methods: This was a prospective, multicentric study from December 1st, 2018 to July 31st, 2019 in two groups: healthy volunteers and cirrhotic patients without clinical signs of hepatic encephalopathy. The results of the Number Connection Test-A (NCT-A), Number Connection Test-B (NCT-B), Serial Dotting Test (SDT), Line Tracing Test (LTT) were expressed in seconds and those of the Digit Symbol Test (DST) in points. Results: A total of 102 healthy volunteers (54 men, 48 women) and 50 cirrhotic patients (29 men, 31 women) were included. The mean age was 38.1 ± 12.55 years in healthy volunteers and 49.3±15.6 years in cirrhotic patients. The mean years of education level was 11.63 ± 4.20 years in healthy volunteers and 9.62±3,9 years in cirrhotic patients. The PHES of the healthy volunteer group was -0.08 ± 1.28 and the cut-off between normal and pathological values was set at −3 points. PHES of the cirrhotic patients was -7.66 ± 5.62 points and significantly lower than that of volunteers (p <0.001). Prevalence of MHE was 74% among cirrhotic patients. Age and education level were associated with MHE.Conclusion: PHES cut-off value in Cameroonians is -3, with MHE prevalence of 74% among cirrhotic patients.

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Section: Discussioncontrasting

confidence: 44%

Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Normalization of the Psychometric Encephalopathy Score in Cameroonian Population

Djomatcho

Kowo

Ndam

et al. 2020

Preprint

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“…It has been reported earlier that the prevalence of MHE among cirrhosis patients may vary from 30% to 84% [ 1 , 19 - 21 ]. This study also confirms that the prevalence of MHE is high among patients with liver cirrhosis as reported previously in the same cohort with a prevalence of 40.2% [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Animal Naming Test – a simple and accurate test for diagnosis of minimal hepatic encephalopathy and prediction of overt hepatic encephalopathy

Agarwal

Taneja

Chopra

et al. 2020

ceh

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Aim of the study Minimal hepatic encephalopathy (MHE) is the mildest form in the spectrum of hepatic encepha-lopathy (HE). We compared the usefulness of the Psychometric Hepatic Encephalopathy Score (PHES) and Animal Naming Test (ANT) for the diagnosis of MHE and the prediction of the development of overt episodes of HE. Material and methods 103 consecutive patients with liver cirrhosis without overt HE were subjected to PHES and ANT evaluation. The receiver-operating characteristic curve was used to determine the optimum cut-off of the ANT value for the diagnosis of MHE. Results Thirty-seven (35.9%) patients had MHE as assessed by altered PHES. ANT (< 14) was positive in 36 (34.95%) patients with MHE with a sensitivity of 89.19% and specificity of 95.7%, positive predictive value (PPV) of 91.67%, negative predictive value (NPV) of 94.03% and diagnostic accuracy of 93.20%. The area under the curve for diagnosis of MHE was 0.978 (95% CI: 0.954-1.0). MHE patients had significantly lower ANT as compared to non-MHE patients and controls (10.81 ±0.324 vs. 15.27 ±0.147 vs. 15.78 ±0.192, respectively, p = 0.01). ANT correlated with PHES ( r = 0.752, p = 0.001) and also with Child-Pugh ( r = –0.408, p = 0.001) and MELD ( r = –0.318, p = 0.001) scores. During follow-up, 14 patients in the MHE group and 4 in the non-MHE group developed overt episodes of HE ( p = 0.001). Conclusions ANT is simple and accurate for the diagnosis of MHE and prediction of overt episodes of HE in patients with cirrhosis and correlates well with the Child-Pugh and MELD scores.

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Prevalence and risk factors for minimal hepatic encephalopathy in cirrhotic patients with different etiologies

Li,

Liu,

Xiang

et al. 2023

Portal Hypertension & Cirrhosis

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AimsMinimal hepatic encephalopathy (MHE) significantly affects the prognosis of patients with cirrhosis. This study was performed to determine whether there is a difference in the prevalence of MHE among patients with cirrhosis of different etiologies and whether the etiology directly influences the occurrence of MHE.MethodsThis multicenter, cross‐sectional study enrolled 1879 patients with confirmed cirrhosis at 40 hospitals from October 25, 2021, to January 10, 2023 (Trial registration: https://clinicaltrials.gov/[NCT05140837]). The patients' demographics, etiologies of cirrhosis, and laboratory test results were collected. The psychometric hepatic encephalopathy score (PHES) was determined in all patients to screen for MHE. Multivariate logistic analyses were performed to identify the risk factors for MHE.ResultsIn total, 736 patients with cirrhosis were analyzed. The prevalence of MHE was 42.0% (n = 309). The primary etiology among all patients was hepatitis B virus (HBV)‐related cirrhosis (71.9% [529/736]). The prevalence of MHE was significantly higher in patients with alcoholic cirrhosis (57.1% [40/70]) than in those with HBV‐related cirrhosis (40.6% [215/529], p = 0.009) or hepatitis C virus (HCV)‐related cirrhosis (38.2% [26/68], p = 0.026). Age (odds ratio [OR], 1.042; 95% confidence interval [CI], 1.024–1.059; p < 0.001), duration of education (OR, 0.935; 95% CI, 0.899–0.971; p = 0.001), etiology (OR, 1.740; 95% CI, 1.028–2.945; p = 0.039), and high MELD‐Na scores (OR, 1.038; 95% CI, 1.009–1.067; p = 0.009) were independent risk factors for MHE. When patients with cirrhosis of different etiologies were analyzed separately, the results showed that age (OR, 1.035; 95% CI, 1.014–1.057; p = 0.001) and duration of education (OR, 0.924; 95% CI, 0.883–0.966; p = 0.001) were risk factors for MHE among patients with HBV‐related cirrhosis, whereas age (OR, 1.138; 95% CI, 1.033–1.254; p = 0.009) and creatinine concentration (OR, 16.487; 95% CI, 1.113–244.160; p = 0.042) were risk factors for MHE in patients with HCV‐related cirrhosis. No risk factors for MHE were found in patients with autoimmune cirrhosis. For patients with alcoholic cirrhosis, the platelet count (OR, 1.014; 95% CI, 1.000–1.027; p = 0.045) was a risk factor for MHE. The PHES subtest results were inconsistent among patients who had MHE with cirrhosis of different etiologies. Patients with HBV‐related cirrhosis performed better on Number Connection Test B and the serial dotting test than those with alcoholic cirrhosis (p = 0.007 and p < 0.001), better on Number Connection Test B than those with HCV‐related cirrhosis (p = 0.020), and better on the line tracing test than those with autoimmune cirrhosis (p = 0.037).ConclusionThe etiology of cirrhosis affected the prevalence of MHE and risk factors for MHE. The domains of major cognitive impairment varied among patients with cirrhosis of different etiologies. Further studies are required to verify these findings.

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

Cited by 26 publications

References 39 publications

Normalization of the Psychometric Encephalopathy Score in Cameroonian Population

Normalization of the Psychometric Encephalopathy Score in Cameroonian Population

Animal Naming Test – a simple and accurate test for diagnosis of minimal hepatic encephalopathy and prediction of overt hepatic encephalopathy

Prevalence and risk factors for minimal hepatic encephalopathy in cirrhotic patients with different etiologies

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