Prevalence and Risk Factors of Minimal Hepatic Encephalopathy in Patients with Compensated Liver Cirrhosis

Elgohary, Marwan N; Amer, Kamal; Bassiony, Mohamed AA

doi:10.21608/ejhm.2020.100204

Prevalence and Risk Factors of Minimal Hepatic Encephalopathy in Patients with Compensated Liver Cirrhosis

Document Type : Original Article

Authors

10.21608/ejhm.2020.100204

Abstract

Background: Minimal hepatic encephalopathy (MHE) is the earliest phase of hepatic encephalopathy. It is associated with increased risk of falls, impaired work and diminished quality of life. Subjects and methods: This study included 302 patients with liver cirrhosis, of which 130 patients had Child A (compensated) liver cirrhosis. All patients were assessed by history taking, clinical examination, routine investigations, serum ammonia level and abdominal ultrasound for porto-systemic shunt (PSS). MHE was diagnosed in 60 patients of compensated liver cirrhosis patients using mini-mental state examination (MMSE) and number connection test A (NCT-A). Results: Our stud showed that Child A patients were 43% of the study group and MHE was present in 46% of compensated liver cirrhosis patients. Our results showed a significant association between lower serum albumin, higher INR, high serum ammonia, presence of PSS in ultrasound examination and MMSE and NCT-A high scores with the development of MHE. MMSE and NCT A showed significantly good performance in diagnosis of MHE. Multiple regression analysis showed that high serum ammonia level (53-61) u/dl, large PSS (> 8 mm in diameter), MMSE score (22-26) and NCT A score (45-56) were the most significant risk factors for MHE. Conclusion: MHE is a major and prevalent manifestation in compensated liver cirrhosis patients. It is associated with significant decrease in work and driving abilities and quality of life. Its major risk factors are high serum ammonia, large PSS and high scores of MMSE and NCT A tests that have a good performance in MHE diagnosis.

Keywords