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

Abstract

Background/objectives

Minimal hepatic encephalopathy (MHE), though highly prevalent, is a frequently underdiagnosed complication of cirrhosis of the liver. Because lack of time is reported as the major reason for non-testing, identifying patients at high risk of MHE would help in targeting them for screening. We aimed to determine the factors associated with MHE to help identify patient subgroups with a higher risk of MHE for targeted screening.

Methods

Patients with cirrhosis of liver presenting between April 2015 and November 2016 were included. Those with a Psychometric Hepatic Encephalopathy Score (PHES) of ≤-5 points on psychometric testing were diagnosed to have MHE. Various demographic, clinical and laboratory parameters were included in a univariate and later multiple logistic regression models.

Results

Of the 180 (male = 166, 92.2%) patients included 94 (52.2%) had MHE. Though serum albumin, serum total bilirubin, serum aspartate aminotransferase, international normalized ration, Child-Turcotte-Pugh and Model-For-End-Stage-Liver-Disease scores were significant on univariate analysis, only CTP score was found to be significantly associated with MHE (P = 0.002) on multivariate analysis. A higher CTP class was associated with a higher risk of the presence of MHE. The Odds ratio for having MHE was higher with CTP classes of B (P ≤ 0.001) and C (P ≤ 0.001) compared to class A.

Conclusions

MHE is a common complication in patients with cirrhosis of liver and higher CTP scores independently predict the presence of MHE. Patients with CTP class B and C have a higher risk of suffering from MHE than CTP class A. Screening of patients in CTP class B and C is likely to increase the MHE detection rates while saving time, although select CTP class A patients may also need screening in view of public safety or poor quality of life.

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  • Authors+Show Affiliations

    ,

    Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal University, Manipal 576104, Karnataka, India.

    ,

    Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal University, Manipal 576104, Karnataka, India.

    ,

    Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal University, Manipal 576104, Karnataka, India.

    ,

    Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal University, Manipal 576104, Karnataka, India.

    Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal University, Manipal 576104, Karnataka, India.

    Source

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    29892178

    Citation

    Bale, Abhijith, et al. "Prevalence of and Factors Associated With Minimal Hepatic Encephalopathy in Patients With Cirrhosis of Liver." Journal of Clinical and Experimental Hepatology, vol. 8, no. 2, 2018, pp. 156-161.
    Bale A, Pai CG, Shetty S, et al. Prevalence of and Factors Associated With Minimal Hepatic Encephalopathy in Patients With Cirrhosis of Liver. J Clin Exp Hepatol. 2018;8(2):156-161.
    Bale, A., Pai, C. G., Shetty, S., Balaraju, G., & Shetty, A. (2018). Prevalence of and Factors Associated With Minimal Hepatic Encephalopathy in Patients With Cirrhosis of Liver. Journal of Clinical and Experimental Hepatology, 8(2), pp. 156-161. doi:10.1016/j.jceh.2017.06.005.
    Bale A, et al. Prevalence of and Factors Associated With Minimal Hepatic Encephalopathy in Patients With Cirrhosis of Liver. J Clin Exp Hepatol. 2018;8(2):156-161. PubMed PMID: 29892178.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Prevalence of and Factors Associated With Minimal Hepatic Encephalopathy in Patients With Cirrhosis of Liver. AU - Bale,Abhijith, AU - Pai,C Ganesh, AU - Shetty,Shiran, AU - Balaraju,Girisha, AU - Shetty,Anurag, Y1 - 2017/06/20/ PY - 2017/04/07/received PY - 2017/06/12/accepted PY - 2018/6/13/entrez PY - 2018/6/13/pubmed PY - 2018/6/13/medline KW - AASLD, The American Association for Study of Liver disease KW - ALT, alanine transaminase KW - AST, aspartate transaminase KW - C.I., confidence interval KW - CTP, Child Turcotte Pugh KW - Child Turcotte Pugh score KW - DST, digit symbol test KW - FCT, figure connection test KW - HE, hepatic encephalopathy KW - HRQOL, health-related quality of life KW - INR, international normalized ratio KW - ISHEN, International Society For Hepatic Encephalopathy and Nitrogen Metabolism KW - K+, potassium KW - Ltt, line tracing test KW - MELD, Model For End-Stage Liver Disease KW - MHE, minimal hepatic encephalopathy KW - NCT, number connection test KW - Na+, sodium KW - OR, odds ratio KW - PHES, psychometric hepatic encephalopathy score KW - Q1,Q3, quartile 1 and quartile 3 KW - SD, standard deviation KW - SDT, serial dotting test KW - SPSS, Statistics Package for Social Sciences KW - TIPS, transjugular intrahepatic portosystemic shunt KW - WBC, white blood cells KW - cirrhosis of liver hepatic encephalopathy KW - psychometric hepatic encephalopathy score SP - 156 EP - 161 JF - Journal of clinical and experimental hepatology JO - J Clin Exp Hepatol VL - 8 IS - 2 N2 - Background/objectives: Minimal hepatic encephalopathy (MHE), though highly prevalent, is a frequently underdiagnosed complication of cirrhosis of the liver. Because lack of time is reported as the major reason for non-testing, identifying patients at high risk of MHE would help in targeting them for screening. We aimed to determine the factors associated with MHE to help identify patient subgroups with a higher risk of MHE for targeted screening. Methods: Patients with cirrhosis of liver presenting between April 2015 and November 2016 were included. Those with a Psychometric Hepatic Encephalopathy Score (PHES) of ≤-5 points on psychometric testing were diagnosed to have MHE. Various demographic, clinical and laboratory parameters were included in a univariate and later multiple logistic regression models. Results: Of the 180 (male = 166, 92.2%) patients included 94 (52.2%) had MHE. Though serum albumin, serum total bilirubin, serum aspartate aminotransferase, international normalized ration, Child-Turcotte-Pugh and Model-For-End-Stage-Liver-Disease scores were significant on univariate analysis, only CTP score was found to be significantly associated with MHE (P = 0.002) on multivariate analysis. A higher CTP class was associated with a higher risk of the presence of MHE. The Odds ratio for having MHE was higher with CTP classes of B (P ≤ 0.001) and C (P ≤ 0.001) compared to class A. Conclusions: MHE is a common complication in patients with cirrhosis of liver and higher CTP scores independently predict the presence of MHE. Patients with CTP class B and C have a higher risk of suffering from MHE than CTP class A. Screening of patients in CTP class B and C is likely to increase the MHE detection rates while saving time, although select CTP class A patients may also need screening in view of public safety or poor quality of life. SN - 0973-6883 UR - https://www.unboundmedicine.com/medline/citation/29892178/Prevalence_of_and_Factors_Associated_With_Minimal_Hepatic_Encephalopathy_in_Patients_With_Cirrhosis_of_Liver_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0973-6883(17)30406-1 DB - PRIME DP - Unbound Medicine ER -