The prognostic significance of subclinical hepatic encephalopathy.
OBJECTIVE
Subclinical hepatic encephalopathy may have prognostic significance with regard to the development of clinical hepatic encephalopathy and survival.


METHODS
We studied 116 consecutive patients with histologically proven cirrhosis of the liver for subclinical hepatic encephalopathy, using Number Connection Test A, Digit Symbol Test, and spectral analysis of the electroencephalogram.


RESULTS
Twenty-five patients (22%) were diagnosed as having subclinical hepatic encephalopathy. Patients with subclinical hepatic encephalopathy were older, had a higher Child-Pugh score, and more often had esophageal or gastric varices and episode(s) of clinical hepatic encephalopathy in their history. During a median follow-up of 29 months (range, 1-49 months), patients with subclinical hepatic encephalopathy significantly more often had episodes of clinical hepatic encephalopathy; survival, however, was similar to that of patients without subclinical hepatic encephalopathy, and was determined mainly by the Child-Pugh score. The Child-Pugh score was also superior to subclinical hepatic encephalopathy in predicting episodes of clinical hepatic encephalopathy.


CONCLUSIONS
The prognostic significance of subclinical hepatic encephalopathy appears limited.
Hartmann
I J
IJ
Department of Hepatogastroenterology, Erasmus University Hospital Rotterdam, The Netherlands.
Groeneweg
M
M
Quero
J C
JC
Beijeman
S J
SJ
de Man
R A
RA
Hop
W C
WC
Schalm
S W
SW
D000293:Adolescent; D000328:Adult; D000368:Aged; D004569:Electroencephalography; D004932:Esophageal and Gastric Varices / Q000150:complications; D005260:Female; D006501:Hepatic Encephalopathy / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011379:Prognosis; D012720:Severity of Illness Index; D016019:Survival Analysis