[Minimal hepatic encephalopathy: a better diagnostic to improve prognostic].
OBJECTIVE
Minimal hepatic encephalopathy (MHE) is the mildest form of the spectrum of hepatic encephalopathy that impairs health-related quality of life. The aim of this study is to evaluate the prevalence of MHE in patients with liver cirrhosis and analyze risk factors.


METHODS
Between September 2011 and December 2012, consecutive cirrhotic patients seen in our department were evaluated. Patients included were screened by the psychometric hepatic encephalopathy score (PHES) battery comprising 5 tests: number connection test A and B, line tracing test, serial dotting test and digit symbol test. Patients included were regularly followed-up for the development of overt hepatic encephalopathy, driving accidents, falls and death.


RESULTS
We included 45 cirrhotic patients. Etiology of cirrhosis was viral in half of cases. Child-Pugh score was A in 55.6 %, B in 26.7 % and C in 17.8 %. Median Meld score was 14. According to the PHES score, MHE was detected in 44.4 % of patients. Univariate analysis identified 4 variables significantly associated with the presence of MHE: age ≥ 55 years (P=0.031), poor educational status with years of study< 9 years (P=0.007), MELD score ≥ 15 (P=0.002) and Child-Pugh ≥ 7 (P=0.001). At multivariate analysis, the only independent risk factor of MHE was a MELD score≥15 (OR=15.4; P<0.001). During the follow-up, patients with MHE developed more often overt encephalopathy, falls and driving accidents, and had a lower survival, although the difference was not statically significant.


CONCLUSIONS
In this preliminary small series, prevalence of MHE in Tunisian cirrhotic patient was 44.4 %. A MELD score ≥ 15 was the only independent risk factor. MHE had a negative impact on the outcome, justifying an early diagnostic. Adequate therapy may improve cognitive function.
Hôpital Mongi Slim, service d'Hépato-gastro-entérologie, Université de Tunis El Manar, Faculté de médecine de Tunis, 2046 La Marsa, Tunisie. Electronic address: rym.ennaifer@yahoo.fr.
Rym
R
Ennaifer
Hôpital Mongi Slim, service d'Hépato-gastro-entérologie, Université de Tunis El Manar, Faculté de médecine de Tunis, 2046 La Marsa, Tunisie.
Myriam
M
Cheikh
Hôpital Mongi Slim, service d'Hépato-gastro-entérologie, Université de Tunis El Manar, Faculté de médecine de Tunis, 2046 La Marsa, Tunisie.
Rania
R
Hefaiedh
Hôpital Mongi Slim, service d'Hépato-gastro-entérologie, Université de Tunis El Manar, Faculté de médecine de Tunis, 2046 La Marsa, Tunisie.
Hayfa
H
Romdhane
Hôpital Mongi Slim, service d'Hépato-gastro-entérologie, Université de Tunis El Manar, Faculté de médecine de Tunis, 2046 La Marsa, Tunisie.
Houda
H
Ben Nejma
Hôpital Mongi Slim, service d'Hépato-gastro-entérologie, Université de Tunis El Manar, Faculté de médecine de Tunis, 2046 La Marsa, Tunisie.
Najet Bel
NB
Hadj
D000328:Adult; D000368:Aged; D042241:Early Diagnosis; D005260:Female; D006501:Hepatic Encephalopathy / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index