Abstract : Background & Aims: Minimal hepatic encephalopathy (MHE) is the mildest form of the spectrum of hepa
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Abstract : Background & Aims: Minimal hepatic encephalopathy (MHE) is the mildest form of the spectrum of hepatic encephalopathy that impairs health-related quality of life. We assessed (1) the usefulness of psychometric hepatic encephalopathy score (PHES) and critical flicker frequency (CFF) for the diagnosis of MHE and (2) prognostic significance of MHE. Methods: One-hundred-patients with liver cirrhosis without overt HE were subjected to PHES and CFF evaluation. Eighty-three age- and sex-matched healthy volunteers served as controls. MHE was diagnosed when the PHES was =-5. An age-adjusted Z score < -2 on the CFF was considered abnormal. Results: Forty-eight (48%) patients had MHE as indicated by altered PHES. CFF was altered in 21 patients; 17 also showed impaired PHES thus providing additional information in only 4 patients. Forty-six of 48 patients with MHE and 48 of 52 patients without MHE completed the follow-up. Eighteen (39.1%) patients died among those who had MHE compared to 11 (22.9%) patients who did not have MHE. Among the several variables analyzed in this study, univariate analyses showed that age, serum bilirubin level, Child-Turcotte-Pugh score and PHES were associated with a poor prognosis. The multivariate analysis identified two variables as significant independent prognostic factors; PHES =-6 [hazard ratio 2.419 (95% CI, 1.014 – 5.769)] and Child-Turcotte-Pugh score =8 [hazard ratio 2.466 (95% CI, 1.010 – 6.023)] predicted poor survival. Conclusions: PHES has prognostic value on survival, in addition to Child-Turcotte-Pugh score. PHES appears to be an ideal assessment tool for the diagnosis of MHE in an outpatient setting.- Slides
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