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Minimal hepatic encephalopathy in patients with cirrhosis by measuring liver stiffness and hepatic venous pressure gradient.
Saudi J Gastroenterol 2012 Sep-Oct; 18(5):316-21SJ

Abstract

BACKGROUND/AIM

Transient elastography (TE) of liver and hepatic venous pressure gradient (HVPG) allows accurate prediction of cirrhosis and its complications in patients with chronic liver disease. There is no study on prediction of minimal hepatic encephalopathy (MHE) using TE and HVPG in patients with cirrhosis.

PATIENTS AND METHODS

Consecutive cirrhotic patients who never had an episode of hepatic encephalopathy (HE) were enrolled. All patients were assessed by psychometry (number connection test (NCT-A and B), digit symbol test (DST), serial dot test (SDT), line tracing test (LTT)), critical flicker frequency test (CFF), TE by FibroScan and HVPG. MHE was diagnosed if there were two or more abnormal psychometry tests (± 2 SD controls).

RESULTS

150 patients with cirrhosis who underwent HVPG were screened; 91 patients (61%, age 44.0 ± 11.4 years, M:F:75:16, Child's A:B:C 18:54:19) met the inclusion criteria. Fifty three (58%) patients had MHE (Child A (7/18, 39%), Child B (32/54, 59%) and Child C (14/19, 74%)). There was no significant difference between alanine aminotranferease (ALT), aspartate aminotransferase (AST) and total bilirubin level in patients with MHE versus non MHE. Patients with MHE had significantly lower CFF than non MHE patients (38.4 ± 3.0 vs. 40.2 ± 2.2 Hz, P = 0.002). TE and HVPG in patients with MHE did not significantly differ from patients with no MHE (30.9 ± 17.2 vs. 29.8 ± 18.2 KPas, P = 0.78; and 13.6 ± 2.7 vs. 13.6 ± 3.2 mmHg, P = 0.90, respectively).There was significant correlation of TE with Child's score (0.25, P = 0.01), MELD (0.40, P = 0.001) and HVPG (0.72, P = 0.001) while no correlation with psychometric tests, CFF and MHE.

CONCLUSION

TE by FibroScan and HVPG cannot predict minimal hepatic encephalopathy in patients with cirrhosis.

Authors+Show Affiliations

Department of Hepatology, Institute of Liver and Biliary Science, New Delhi, India. drpraveen_sharma@yahoo.comNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23006459

Citation

Sharma, Praveen, and Ashish Kumar. "Minimal Hepatic Encephalopathy in Patients With Cirrhosis By Measuring Liver Stiffness and Hepatic Venous Pressure Gradient." Saudi Journal of Gastroenterology : Official Journal of the Saudi Gastroenterology Association, vol. 18, no. 5, 2012, pp. 316-21.
Sharma P, Kumar A. Minimal hepatic encephalopathy in patients with cirrhosis by measuring liver stiffness and hepatic venous pressure gradient. Saudi J Gastroenterol. 2012;18(5):316-21.
Sharma, P., & Kumar, A. (2012). Minimal hepatic encephalopathy in patients with cirrhosis by measuring liver stiffness and hepatic venous pressure gradient. Saudi Journal of Gastroenterology : Official Journal of the Saudi Gastroenterology Association, 18(5), pp. 316-21.
Sharma P, Kumar A. Minimal Hepatic Encephalopathy in Patients With Cirrhosis By Measuring Liver Stiffness and Hepatic Venous Pressure Gradient. Saudi J Gastroenterol. 2012;18(5):316-21. PubMed PMID: 23006459.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Minimal hepatic encephalopathy in patients with cirrhosis by measuring liver stiffness and hepatic venous pressure gradient. AU - Sharma,Praveen, AU - Kumar,Ashish, PY - 2012/9/26/entrez PY - 2012/9/26/pubmed PY - 2013/3/15/medline SP - 316 EP - 21 JF - Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association JO - Saudi J Gastroenterol VL - 18 IS - 5 N2 - BACKGROUND/AIM: Transient elastography (TE) of liver and hepatic venous pressure gradient (HVPG) allows accurate prediction of cirrhosis and its complications in patients with chronic liver disease. There is no study on prediction of minimal hepatic encephalopathy (MHE) using TE and HVPG in patients with cirrhosis. PATIENTS AND METHODS: Consecutive cirrhotic patients who never had an episode of hepatic encephalopathy (HE) were enrolled. All patients were assessed by psychometry (number connection test (NCT-A and B), digit symbol test (DST), serial dot test (SDT), line tracing test (LTT)), critical flicker frequency test (CFF), TE by FibroScan and HVPG. MHE was diagnosed if there were two or more abnormal psychometry tests (± 2 SD controls). RESULTS: 150 patients with cirrhosis who underwent HVPG were screened; 91 patients (61%, age 44.0 ± 11.4 years, M:F:75:16, Child's A:B:C 18:54:19) met the inclusion criteria. Fifty three (58%) patients had MHE (Child A (7/18, 39%), Child B (32/54, 59%) and Child C (14/19, 74%)). There was no significant difference between alanine aminotranferease (ALT), aspartate aminotransferase (AST) and total bilirubin level in patients with MHE versus non MHE. Patients with MHE had significantly lower CFF than non MHE patients (38.4 ± 3.0 vs. 40.2 ± 2.2 Hz, P = 0.002). TE and HVPG in patients with MHE did not significantly differ from patients with no MHE (30.9 ± 17.2 vs. 29.8 ± 18.2 KPas, P = 0.78; and 13.6 ± 2.7 vs. 13.6 ± 3.2 mmHg, P = 0.90, respectively).There was significant correlation of TE with Child's score (0.25, P = 0.01), MELD (0.40, P = 0.001) and HVPG (0.72, P = 0.001) while no correlation with psychometric tests, CFF and MHE. CONCLUSION: TE by FibroScan and HVPG cannot predict minimal hepatic encephalopathy in patients with cirrhosis. SN - 1998-4049 UR - https://www.unboundmedicine.com/medline/citation/23006459/Minimal_hepatic_encephalopathy_in_patients_with_cirrhosis_by_measuring_liver_stiffness_and_hepatic_venous_pressure_gradient_ L2 - http://www.saudijgastro.com/article.asp?issn=1319-3767;year=2012;volume=18;issue=5;spage=316;epage=321;aulast=Sharma DB - PRIME DP - Unbound Medicine ER -