title: Subclinical hepatic encephalopathy predicts the development of overt hepatic encephalopathy.
abstract: OBJECTIVE
  In patients with compensated liver cirrhosis the clinical repercussions of detecting subclinical hepatic encephalopathy (SHE) are unclear. We present a long-term follow-up study in cirrhotic patients to examine the relationship between SHE and subsequent episodes of overt hepatic encephalopathy.
  
  
  METHODS
  A total of 63 cirrhotic patients were studied by Number Connection Test and auditory evoked potentials. We determined glutamine, ammonia, zinc, glutamate, urea, and ratio of branched chain amino acids to aromatic amino acids, and Child-Pugh classification.
  
  
  RESULTS
  Of 63 patients, 34 (53%) exhibited SHE. Nineteen out of 63 (30%) developed overt hepatic encephalopathy during follow-up. Hepatic encephalopathy in follow-up was related to alcoholic etiology, ammonia, glutamine, zinc, ratio of branched chain amino acids to aromatic amino acids, liver function, presence of esophageal varices, and detection of SHE (84% of patients who exhibited hepatic encephalopathy in follow-up showed SHE). In Cox-regression, glutamine levels, SHE, esophageal varices, and Child-Pugh class were the independent variables related to hepatic encephalopathy in follow-up.
  
  
  CONCLUSIONS
  SHE (defined on the basis of number connection test or auditory evoked potentials alteration) could predict a subsequent episode of overt hepatic encephalopathy. Lower glutamine levels, presence of esophageal varices, and liver dysfunction were also related to the development of overt hepatic encephalopathy.
authors.affiliation: Hepatology Unit, Hospital Universitario de Valme, Sevilla, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Romero-Gómez
authors.forename: F
authors.initials: F
authors.lastname: Boza
authors.forename: M S
authors.initials: MS
authors.lastname: García-Valdecasas
authors.forename: E
authors.initials: E
authors.lastname: García
authors.forename: J
authors.initials: J
authors.lastname: Aguilar-Reina
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009420:Nervous System / Q000503:physiopathology; D011379:Prognosis; D013997:Time Factors