Minimal Hepatic Encephalopathy: Prevalence and Associated Factors

Introduction: Minimal hepatic encephalopathy (EHM) is a frequent and severe complication of liver disease with a poor prognosis. It is responsible for an altered quality of life for patients. However, it is a poorly understood complication. There is no consensus on the diagnosis itself. Consequently, this pathology is under-diagnosed.

The main objective of this study is to definite in cirrhotic cases the frequence of minimal hepatic encephalopathy (EHM), cases with no clinical hepatic encephalopathy and to identify its risk factors.

Materials and Methods: This is a prospective study. 40 patients were included over a period of one year. A psychometric score of hepatic encephalopathy (PHES) composed of 5 tests was calculated. Any patient with a PHES score < -4 had an EHM.

Results: We recruited 40 patients. The study population was characterized by a slight male predominance (60%), the average age of the patients was 60.7 ± 11.8 years. The prevalence of EHM was 42.5% and varied according to the Child-Pugh class of the patients (Child A: 11.76%, Child B: 47.06% and Child C: 41.18%). Thrombocytopenia, hypoalbuminemia and elevated ASAT were found to be independent predictors of EHM in cirrhotic patients.

Conclusion: The Psychometric Hepatic Encephalopathy Score (PHES) has been shown to be useful for the diagnosis of EHM and can be applied both in the outpatient setting and at the patient's bed. The frequency of EHM in our study was 42.5%. Its independent risk factors can be used as a screening tool in cirrhotic patients. Larger studies should be encouraged.