Minimal hepatic encephalopathy runs a fluctuating course: results from a three-year prospective cohort follow-up study.
BACKGROUND
Minimal hepatic encephalopathy (mHE) has been reported in up to 84 percent of cirrhotics. The natural history of mHE has not been well-described. We designed a three-year prospective cohort study to determine the prevalence and natural history of mHE among cirrhotic patients.


METHODS
The patient cohort comprising 62 consecutive outpatients with cirrhosis were assessed at baseline and followed-up with a repeat assessment three years later. The assessments include: (1) Neuropsychometric analysis (digit-symbol substitution test, block-design test, number-connection test A); (2) Clinical, biochemical assessment; and (3) Quality of life (QOL) assessment (abbreviated sickness impact profile).


RESULTS
Baseline characteristics were: age 52.9 +/- 11.0 years; Child's A:B:C was 46:14:2. mHE was detected in 33.9 percent of the cohort. Older age, a higher Child-Pugh score and female gender were independently associated with mHE. mHE was associated with a poorer QOL. Follow-up assessment three years later showed that seven patients had died, while six were lost to follow-up; these patients had significantly higher baseline Child's scores. Of the remaining patients, 36/49 (73 percent) agreed to a repeat evaluation. In this group, none had mHE. QOL remained impaired despite the resolution of mHE.


CONCLUSIONS
It has been shown for the first time that mHE can revert to a normal state in a significant proportion of patients with well-compensated cirrhosis.
Department of Gastroenterology and Hepatology, Singapore General Hospital, Outram Road, Singapore 169608. tan.hui.hui@sgh.com.sg
H H
HH
Tan
G H
GH
Lee
K T J
KT
Thia
H S
HS
Ng
W C
WC
Chow
H F
HF
Lui
D000367:Age Factors; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D015995:Prevalence; D011446:Prospective Studies; D011594:Psychometrics; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013997:Time Factors