Prevalence And Risk Factors Of Minimal Hepatic Encephalopathy In Decompensated Cirrhosis

Background:Minimal hepatic encephalopathy(MHE)occurs in the early stages of hepatic encephalopathy, often has no obvious clinical manifestations of hepatic encephalopathy, but may refer to a mild neurocognitive impairment. MHE may affect health-related quality of life(HRQo L) of patients. A considerable number of liver cirrhosis patients with MHE can develop into overt hepatic encephalopathy within a relatively short period. Currently, there is still a lack of gold standard for the diagnosis of MHE, but it can be detected by neuropsychological tests, neurophysiological tests and radiographic examination. Objective:1. To investigate the prevalence of minimal hepatic encephalopathy in decompensated cirrhosis patients.2. To compare the coincidence rate between neuropsychological test and subjective judgment of senior liver disease specialist in the diagnosis of MHE.3. To analysis the risk factors associated with minimal hepatic encephalopathy. Method:According to the inclusive and exclusive criteria, a total of 213 consecutive hospitalized patients with decompensated cirrhosis were selected from May 2015 to December 2015 from department of Gastroenterology, the First Affiliated Hospital of Nanchang University, They were both detected by the neuropsychological test including number connection test-A(NCT-A) and digit symbol test(DST) respectively. MHE was diagnosed when the results of NCT-A and DST both presented abnormal, Otherwise, it was diagnosed non-MHE. All selected patients accepted the subjective judgment of senior liver disease specialist with more than 10 years of clinical experience to estimate whether the patient accompanied with MHE. The relevant data of all included patients, such as clinical, laboratory and radiological results, was collected. The severity of impaired liver function of patient with decompensated cirrhosis was evaluated by Child-Pugh score and MELD score. Results:1. In 213 patients with decompensated cirrhosis, 133 patients(62.4%) had single abnormal results of NCT-A, and 61 patients(28.6%) had single abnormal results of DST. In total, 56 patients(26.3%) had abnormal results in both NCT-A and DST, and they were diagnosed with MHE. The relevance ratio of MHE was 26.3%. Among them, the detection rate of the male and female patients with MHE was 26.9% and 24.6% respectively, the detection rate of MHE in Child-Pugh grade A, B, C was 22.1% and 34.4%, 26.7% respectively. They were both with no significant difference. The case in Liver cirrhosis combined with hepatitis B was 160, the detection rate of MHE was 25.6%. There were a total of 53 cases of non-hepatic B cirrhosis, the detection rate of MHE was 28.3%.2. The difference between subjective judgment of senior liver disease specialist and neuropsychological test when diagnosing MHE was statistically significant(P <0.01), and the total coincidence rate was 80.8%, kappa=0.506, which had a moderate consistency.3. Compared with non-MHE patients, A/G ratio(p<0.001), ALT(P<0.05), Child-Pugh score(P<0.05), MELD score(P<0.05) were significantly different in the MHE patients in all included objects. Among them, A/G ratio(OR=0.205, 95% CI: 0.081~0.397) and Child-Pugh score(OR=1.556, 95% CI: 1.307 ~1.853) were the risk factors of MHE.4. After the analysis of the inner diameter of liver-related blood supply vessels including the portal vein, portal around artery and splenic vein, we found the difference between the MHE and non-MHE patients was not statistically significant.5. Through correlation analysis, it showed that the level of A/G ratio was correlated with the result of NCT-A(r=0.228, P<0.01) and DST(r=-0.197, P<0.01). By analysis of the correlation between MHE and non-MHE group respectively, we found that A/G ratio was correlated with DST(r=0.367, P<0.01) and NCT-A(r=-0.382, P<0.01) in MHE group and there was no correlation in non-MHE group. Conclusion:1. The detection rate of MHE in patients with decompensated cirrhosis was 26.3%, and there was no difference in the detection rate of different levels of the classification of Child-Pugh.2. The subjective judgment of liver disease specialist and neuropsychological test to diagnose MHE had moderate consistency. But the subjective judgment of liver disease specialistcan was not recommended for use in diagnosis of MHE, it was proposed to use the objective examination to screen MHE.3. Low A/G ratio and high Child-Pugh score were the risk factors of MHE.