title: Previous overt hepatic encephalopathy rather than minimal hepatic encephalopathy impairs health-related quality of life in cirrhotic patients.
abstract: BACKGROUND
  It has been observed that overt hepatic encephalopathy (HE) is accompanied by a persistent cognitive defect, suggesting that HE may not be fully reversible. The health-related quality-of-life (HRQoL) has been shown to be impaired by cirrhosis, and, according to some reports, influenced by minimal HE. Little is known about the effect of previous HE on HRQoL.
  
  
  OBJECTIVE
  To investigate the relative impact of previous HE and minimal HE on HRQoL in a group of consecutively hospitalized cirrhotic patients.
  
  
  METHODS
  Seventy five consecutive cirrhotic patients were evaluated using the Psychometric HE Score (PHES) and simplified Psychometric HE Score (SPHES) to detect the presence of minimal HE and using SF-36 to assess the HRQoL, both corrected for age and education. Eighteen of them had previous bouts of overt HE.
  
  
  RESULTS
  Minimal HE was significantly more frequent in patients with previous HE than in those without (p < 0.001), independently on the method used for the diagnosis (PHES or SPHES). A deeper impairment in several domains of SF-36 was observed in patients with previous bouts of overt HE, in those with ascites, as well as in those with decompensated cirrhosis. At multivariate analysis, ascites, MELD score and previous HE were independently related to the mental-component-summary (MCS) of SF-36, whereas ascites was the only variable independently associated with the physical-component-summary (PCS) of SF-36. Minimal HE (independently on the method used for its diagnosis) impaired only one domain of SF-36.
  
  
  CONCLUSIONS
  These data suggest that previous bouts of HE, despite their complete clinical resolution, play an independent role in producing a persistent impairment in HRQoL of cirrhotics.
authors.affiliation: Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Moscucci
authors.forename: Silvia
authors.initials: S
authors.lastname: Nardelli
authors.forename: Ilaria
authors.initials: I
authors.lastname: Pentassuglio
authors.forename: Chiara
authors.initials: C
authors.lastname: Pasquale
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Ridola
authors.forename: Manuela
authors.initials: M
authors.lastname: Merli
authors.forename: Oliviero
authors.initials: O
authors.lastname: Riggio
mesh_terms: D000368:Aged; D005260:Female; D006501:Hepatic Encephalopathy / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011594:Psychometrics / Q000379:methods; D011788:Quality of Life / Q000523:psychology*; D012044:Regression Analysis; D011795:Surveys and Questionnaires