Prevalence of minimal hepatic encephalopathy and quality of life in patients with decompensated cirrhosis

Mina, Aline; Morán, Segundo; Ortiz-Olvera, Nayeli X.; Mera, Robertino; Uribe, Misael

doi:10.1111/hepr.12227

Cited by 53 publications

(41 citation statements)

References 49 publications

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“…We found 45.7% of cirrhotic patients to have MHE by MRS which is within the reported range of prevalence in different studies dependent on the diagnostic criteria used (30-84%) [1,2,5].…”

Section: Discussionsupporting

confidence: 86%

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Minimal hepatic encephalopathy in patients with liver cirrhosis: Magnetic resonance spectroscopic brain findings versus neuropsychological changes

Hassan

El-Rehim

Seifeldein

et al. 2014

Arab Journal of Gastroenterology

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“…We found 45.7% of cirrhotic patients to have MHE by MRS which is within the reported range of prevalence in different studies dependent on the diagnostic criteria used (30-84%) [1,2,5].…”

Section: Discussionsupporting

confidence: 86%

“…In Western countries, using specific neuropsychological and/or neurophysiological testing reported rates of MHE range between 30% and 84% of patients with cirrhosis depending upon the definition and diagnostic tool of MHE [1,2,5]. However, there is lack of data on diagnosis and prevalence in MHE in our locality.…”

Section: Introductionmentioning

confidence: 90%

Minimal hepatic encephalopathy in patients with liver cirrhosis: Magnetic resonance spectroscopic brain findings versus neuropsychological changes

Hassan

El-Rehim

Seifeldein

et al. 2014

Arab Journal of Gastroenterology

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“…[44][45][46][47] MHE adversely affects HRQOL as shown by various studies. 11,41,43,[48][49][50] Complex activities which require attention or information processing and psychomotor skills are mainly affected, such as driving a car or planning a trip. Basic functions of day to day self-care like personal hygiene, dressing and shopping are preserved.…”

Section: Effect Of Minimal Hepatic Encephalopathy On Quality Of Lifementioning

confidence: 99%

“…MHE also reduces appetite in cirrhotics and as the liver dysfunction worsens, malnutrition occurs which adversely impacts HRQOL. 49 Depression, anxiety-trait and alexithymic symptoms occurs in cirrhotics and are major determinants of impaired HRQOL. 50 Treatment of MHE with lactulose, 11 rifaximin 27,51 or probiotics 29 reverses MHE in majority of patients.…”

Section: Effect Of Minimal Hepatic Encephalopathy On Quality Of Lifementioning

confidence: 99%

Minimal Hepatic Encephalopathy Impairs Quality of Life

Agrawal

Umapathy

Dhiman

2015

Journal of Clinical and Experimental Hepatology

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Minimal hepatic encephalopathy (MHE) is the mildest form of the spectrum of neurocognitive impairment in cirrhosis. It is a frequent occurrence in patients of cirrhosis and is detectable only by specialized neurocognitive testing. MHE is a clinically significant disorder which impairs daily functioning, driving performance, work capability and learning ability. It also predisposes to the development of overt hepatic encephalopathy, increased falls and increased mortality. This results in impaired quality of life for the patient as well as significant social and economic burden for health providers and care givers. Early detection and treatment of MHE with ammonia lowering therapy can reverse MHE and improve quality of life. ( J CLIN EXP HEPATOL 2015;5:S42-S48) H epatic encephalopathy (HE) is a neurocognitive disorder in which brain function is impaired and is associated with both acute and chronic liver dysfunction. 1 It is a major complication that develops in some form and at some stage in a majority of patients with liver cirrhosis. Minimal HE (MHE) is the mildest form of spectrum of HE which is characterized by subtle cognitive and psychomotor deficits in the absence of recognizable clinical symptoms of HE. 2 It occurs in patients with liver dysfunction and/or portosystemic shunts. In MHE, neurocognitive abnormalities primarily affect attention, speed of information processing, executive control, motor ability and coordination in an individual. 3 In 1970, Zeegen et al 4 first described this condition when they discovered that 38% of patients who had undergone portal decompression surgery scored abnormal in Reitan trail making test (number connection test). Eight years later, the term subclinical HE 5 was introduced to describe these patients. Since then, this condition was described under various names like early HE, latent HE, subclinical HE and finally minimal HE. The latest classification combines MHE and grade 1 HE into covert HE while higher grades are classified as overt HE, thus simplifying the clinical schema so that HE can be uniformly diagnosed. 6 Covert HE means that the mental defect is not detectable by the clinician using conventional testing and is not noticeable to the patient. However, it is significant because these patients usually have neuropsychiatric and neurophysiological abnormalities on advanced testing which are not enough to cause disorientation or asterixis. MHE is regarded as a preclinical stage of HE and ammonia and systemic inflammation plays an important role in its pathogenesis similar to HE. Ammonia lowering therapies were used in the treatment of MHE and found to be effective.MHE is clinically significant as it impairs daily functioning, health related quality of life (HRQOL) and driving skills, predicts the development of overt HE and is associated with poor survival. 7-11 Overt HE develops in >50% of MHE patients within three years. 10 These patients pose a significant burden to their care givers depending on the severity of cognitive dysfunction. 2,12 Considering all ...

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“…MHE has a negative impact on daily life activities and working capacity, 10 affects health-related quality of life (HRQoL), [11][12][13][14][15] impairs fitness to drive, [16][17][18] is associated with motor vehicle crashes 19,20 and predisposes the patient to falls. 20,21 Furthermore, MHE is of prognostic significance as it is a risk factor for the development of overt HE 20,[22][23][24][25] and death.…”

Section: 9mentioning

confidence: 99%

Minimal Hepatic Encephalopathy: The Reality Beyond Our Eyes

et al. 2015

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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...

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Prevalence of minimal hepatic encephalopathy and quality of life in patients with decompensated cirrhosis

Abstract: The results suggest that MHE and a reduction in appetite are associated with deterioration in HRQL in patients with decompensated cirrhosis.

Cited by 53 publications

References 49 publications

Minimal hepatic encephalopathy in patients with liver cirrhosis: Magnetic resonance spectroscopic brain findings versus neuropsychological changes

Minimal hepatic encephalopathy in patients with liver cirrhosis: Magnetic resonance spectroscopic brain findings versus neuropsychological changes

Minimal Hepatic Encephalopathy Impairs Quality of Life

Minimal Hepatic Encephalopathy: The Reality Beyond Our Eyes

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