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Prevalence of Minimal Hepatic Encephalopathy in Patients With Liver Cirrhosis: A Multicenter Study

医学 肝性脑病 肝硬化 内科学 肝病 胃肠病学 队列 终末期肝病模型 脑病 肝移植 移植
作者
Simon Johannes Gairing,Chiara Mangini,Lisa Zarantonello,Stefania Gioia,Elise Jonasson Nielsen,Sven Danneberg,Maria M. Gabriel,Alena F. Ehrenbauer,Patricia P. Bloom,Cristina Ripoll,Philippe Sultanik,Peter R. Galle,Joachim Labenz,Dominique Thabut,Alexander Zipprich,Anna S. Lok,Karin Weißenborn,Jens U. Marquardt,Mette Munk Lauridsen,Silvia Nardelli,Sara Montagnese,Christian Labenz
出处
期刊:The American Journal of Gastroenterology [Lippincott Williams & Wilkins]
卷期号:118 (12): 2191-2200 被引量:14
标识
DOI:10.14309/ajg.0000000000002251
摘要

The prevalence of minimal hepatic encephalopathy (MHE), in particular in different subgroups, remains unknown. This study aimed to analyze the prevalence of MHE in different subgroups to identify patients at high risk and to pave the way for personalized screening approaches.In this study, data of patients recruited at 10 centers across Europe and the United States were analyzed. Only patients without clinical signs of hepatic encephalopathy were included. MHE was detected using the Psychometric Hepatic Encephalopathy Score (PHES, cut-off < or ≤-4 depending on local norms). Clinical and demographic characteristics of the patients were assessed and analyzed.In total, 1,868 patients with cirrhosis with a median model for end-stage liver disease (MELD) of 11 were analyzed (Child-Pugh [CP] stages: A 46%, B 42%, and C 12%). In the total cohort, MHE was detected by PHES in 650 patients (35%). After excluding patients with a history of overt hepatic encephalopathy, the prevalence of MHE was 29%. In subgroup analyses, the prevalence of MHE in patients with CP A was low (25%), whereas it was high in CP B or C (42% and 52%). In patients with a MELD score <10, the prevalence of MHE was only 25%, but it was 48% in patients with a MELD score ≥20. Standardized ammonia levels (ammonia level/upper limit of normal of each center) correlated significantly, albeit weakly with PHES (Spearman ρ = -0.16, P < 0.001).The prevalence of MHE in patients with cirrhosis was high but varied substantially between diseases stages. These data may pave the way for more individualized MHE screening approaches.
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