Screening for minimal hepatic encephalopathy in patients with cirrhosis by cirrhosis-related symptoms and a history of overt hepatic encephalopathy

Abstract

Abstract. The diagnosis of minimal hepatic encephalopathy (MHE) is more difficult in comparison to the diagnosis of overt hepatic encephalopathy (OHE), as patients with MHE do not exhibit overt neurological deficits and must be diagnosed using specialized equipment. However, identifying MHE is critical for patients with cirrhosis, and a simple screening test is required. The present study aimed to evaluate the associations between MHE, clinical characteristics and questionnaire items regarding sleep disturbances and cirrhosis-related symptom score (CSS). A total of 91 patients who had cirrhosis without OHE were evaluated using various questionnaires [i.e., CSS, Epworth Sleepiness Scale, the Japanese version of the Pittsburgh Sleep Quality Index (PSQI) and the Japanese 36-item short-form health survey (SF-36)]. MHE was diagnosed using the neuropsychological test. MHE was associated with severe liver damage, which was indicated by liver damage markers and a history of OHE. In addition, MHE was associated with the CSS, PSQI and SF-36 results. The multivariate analyses revealed that a history of OHE was the factor that was the most strongly associated with MHE. Among patients without a history of OHE, MHE was most strongly associated with CSS, although it was also associated with severe liver damage and platelet counts. A prediction score (calculated using a history of OHE and CSS) provided an area under the receiver operating characteristic curve of 0.738 and a sensitivity of 0.671 for identifying MHE. In conclusion, a history of OHE and CSS may be useful for identifying MHE in patients with cirrhosis.

Hepatitis C virus‐related symptoms, but not quality of life, were improved by treatment with direct‐acting antivirals

“…A poor sleeper had 10 or more points on the ESS and 6 or more points on the PSQI. We have previously shown that minimal hepatic encephalopathy is correlated with 9 or more points on the CSS . Psychological distress is defined as 13 points or more on the K‐6.…”

“…An “impact factor” for each item was calculated, which was defined as the product of the frequency of the item and the mean importance that the patients attributed to the item. The impact factor for each item ranged from 0 to 3, and the CSS was calculated as the sum of the impact factors . The ESS was used to evaluate daytime hypersomnolence; ESS scores range from 0 to 24, and a score of ≥10 indicates significant daytime hypersomnolence.…”

“…The cirrhosis-related symptom score (CSS), used for total evaluation of chronic liver disease, is correlated with the Child-Pugh score and minimal hepatic encephalopathy. 9 The restless legs syndrome (RLS) is a common complication of cirrhosis and affects sleep status as evaluated by the Pittsburg sleep quality index (PSQI), and QOL is evaluated by the SF-36. 10 The Epworth sleepiness scale (ESS) in patients with cirrhosis can be improved by ingestion of branched chain amino acid supplements.…”

Study of the sleep quality and psychological state of patients with hepatitis B liver cirrhosis

“…Mild defects of MHE cognitive function can sometimes be detected through specific methods such as mental assessment scales or neuropsychiatric testing. Currently, a worldwide consensus on the diagnostic criterion for MHE is absent, and the diagnosis of MHE is difficult . It is common to use more than two sensitive neuropsychological tests.…”

Blood carnitine profiling on tandem mass spectrometry in liver cirrhotic patients

“…The cirrhosis-related symptom scores (CSS) questionnaire, which we developed, was used to evaluate cirrhosis symptoms [9]. The Epworth Sleepiness Scale (ESS) was used to evaluate daytime hypersomnolence [10].…”