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Screening for minimal hepatic encephalopathy in asymptomatic drivers with liver cirrhosis.

Abstract

BACKGROUND AND STUDY AIMS

Minimal hepatic encephalopathy (MHE) represents a part of the spectrum of hepatic encephalopathy (HE). It can have a far-reaching impact on quality and ability to function in daily life and may progress to overt HE. This study was designed to screen for MHE in drivers with liver cirrhosis in Mansoura, a city in the Nile delta in Egypt.

PATIENTS AND METHODS

A total of 174 consecutive drivers with positive serology for viral markers and cirrhosis were screened for MHE. Questionnaires and standard psychometric tests and well-informed consent were performed at the same setting. The diagnosis of MHE was made when one or both symbol digit test (SDT) and number connection test (NCT) appeared abnormal. Beck's inventory and Mini Mental State Examination questionnaires were performed for those diagnosed as MHE. After overnight fasting, venous blood samples were taken for haematologic tests and routine liver function tests by conventional methods. Arterial ammonia was also measured.

RESULTS

A total of 66 patients showed evidence for MHE out of 139 patients who fulfilled the inclusion criteria. No significant differences were present, apart from a significantly elevated arterial ammonia level (p-value <0.001) and a bad self-reported driving history (p<0.05) in the MHE-positive group when compared with the MHE-negative group. Multivariate logistic regression revealed that advanced Child-Pugh grade (p<0.001), hepatitis B virus (HBV)-related aetiology (p<0.001) and smoking are significant risk factors for MHE. MHE is significantly commoner among Child-Pugh C patients (p<0.05) when compared with the other Child-Pugh grades.

CONCLUSION

Our data revealed a high prevalence of MHE (47%) among Egyptian drivers with liver cirrhosis. It is hence recommended to include the driving history as well as regular pencil-paper standard psychometric testing in evaluating those at risk, especially in the outpatient setting, for early detection and proper management.

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  • Authors+Show Affiliations

    ,

    Internal Medicine Department, Mansoura Specialized Medical Hospital, Mansoura University, Mansoura, Egypt. Yahiazgad@yahoo.com

    , , ,

    Source

    MeSH

    Adult
    Automobile Driving
    Egypt
    Hepatic Encephalopathy
    Hepatitis B
    Humans
    Liver Cirrhosis
    Logistic Models
    Mass Screening
    Middle Aged
    Psychometrics
    Smoking
    Surveys and Questionnaires
    Young Adult

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    21684474

    Citation

    Gad, Yahia Z., et al. "Screening for Minimal Hepatic Encephalopathy in Asymptomatic Drivers With Liver Cirrhosis." Arab Journal of Gastroenterology : the Official Publication of the Pan-Arab Association of Gastroenterology, vol. 12, no. 2, 2011, pp. 58-61.
    Gad YZ, Zaher AA, Moussa NH, et al. Screening for minimal hepatic encephalopathy in asymptomatic drivers with liver cirrhosis. Arab J Gastroenterol. 2011;12(2):58-61.
    Gad, Y. Z., Zaher, A. A., Moussa, N. H., El-desoky, A. E., & Al-Adarosy, H. A. (2011). Screening for minimal hepatic encephalopathy in asymptomatic drivers with liver cirrhosis. Arab Journal of Gastroenterology : the Official Publication of the Pan-Arab Association of Gastroenterology, 12(2), pp. 58-61. doi:10.1016/j.ajg.2011.04.002.
    Gad YZ, et al. Screening for Minimal Hepatic Encephalopathy in Asymptomatic Drivers With Liver Cirrhosis. Arab J Gastroenterol. 2011;12(2):58-61. PubMed PMID: 21684474.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Screening for minimal hepatic encephalopathy in asymptomatic drivers with liver cirrhosis. AU - Gad,Yahia Z, AU - Zaher,Ashraf A, AU - Moussa,Nasser H, AU - El-desoky,Abd-Elmohsen E, AU - Al-Adarosy,Hala A, Y1 - 2011/06/12/ PY - 2010/11/15/received PY - 2010/12/08/revised PY - 2011/04/02/accepted PY - 2011/6/21/entrez PY - 2011/6/21/pubmed PY - 2011/12/13/medline SP - 58 EP - 61 JF - Arab journal of gastroenterology : the official publication of the Pan-Arab Association of Gastroenterology JO - Arab J Gastroenterol VL - 12 IS - 2 N2 - BACKGROUND AND STUDY AIMS: Minimal hepatic encephalopathy (MHE) represents a part of the spectrum of hepatic encephalopathy (HE). It can have a far-reaching impact on quality and ability to function in daily life and may progress to overt HE. This study was designed to screen for MHE in drivers with liver cirrhosis in Mansoura, a city in the Nile delta in Egypt. PATIENTS AND METHODS: A total of 174 consecutive drivers with positive serology for viral markers and cirrhosis were screened for MHE. Questionnaires and standard psychometric tests and well-informed consent were performed at the same setting. The diagnosis of MHE was made when one or both symbol digit test (SDT) and number connection test (NCT) appeared abnormal. Beck's inventory and Mini Mental State Examination questionnaires were performed for those diagnosed as MHE. After overnight fasting, venous blood samples were taken for haematologic tests and routine liver function tests by conventional methods. Arterial ammonia was also measured. RESULTS: A total of 66 patients showed evidence for MHE out of 139 patients who fulfilled the inclusion criteria. No significant differences were present, apart from a significantly elevated arterial ammonia level (p-value <0.001) and a bad self-reported driving history (p<0.05) in the MHE-positive group when compared with the MHE-negative group. Multivariate logistic regression revealed that advanced Child-Pugh grade (p<0.001), hepatitis B virus (HBV)-related aetiology (p<0.001) and smoking are significant risk factors for MHE. MHE is significantly commoner among Child-Pugh C patients (p<0.05) when compared with the other Child-Pugh grades. CONCLUSION: Our data revealed a high prevalence of MHE (47%) among Egyptian drivers with liver cirrhosis. It is hence recommended to include the driving history as well as regular pencil-paper standard psychometric testing in evaluating those at risk, especially in the outpatient setting, for early detection and proper management. SN - 2090-2387 UR - https://www.unboundmedicine.com/medline/citation/21684474/Screening_for_minimal_hepatic_encephalopathy_in_asymptomatic_drivers_with_liver_cirrhosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1687-1979(11)00039-6 DB - PRIME DP - Unbound Medicine ER -