Covert hepatic encephalopathy is associated with aggressive disease progression and poor survival in patients with cirrhosis

Objectives Covert hepatic encephalopathy (CHE) negatively affects the health‐related quality of life and increases the risk of overt HE (OHE) in patients with liver cirrhosis. However, the impact of CHE on long‐term patient outcomes remains controversial. This study aimed to explore the association between CHE and disease progression and survival among cirrhotic patients. Methods This was a single‐center prospective study that enrolled 132 hospitalized patients with cirrhosis, with an average follow‐up period of 45.02 ± 23.06 months. CHE was diagnosed using the validated Chinese standardized psychometric hepatic encephalopathy score. Results CHE was detected in 35.61% cirrhotic patients. During the follow‐up, patients with CHE had a higher risk of developing OHE (log‐rank 5.840, P = 0.016), exacerbation of ascites (log‐rank 4.789, P = 0.029), and portal vein thrombosis (PVT) (log‐rank 8.738, P = 0.003). Cox multivariate regression analyses revealed that CHE was independently associated with the occurrence of OHE, exacerbation of ascites, and PVT. Furthermore, patients with progression of cirrhosis were more likely to be diagnosed as CHE (log‐rank 4.462, P = 0.035). At the end of the follow‐up, patients with CHE had a lower survival rate compared to those without CHE (log‐rank 8.151, P = 0.004). CHE diagnosis (hazard ratio 2.530, P = 0.008), together with elder age and higher Child–Pugh score, were risk factors for impaired survival in cirrhotic patients. Conclusion CHE is associated with disease progression and poor survival in patients with cirrhosis, indicating that CHE may serve as an independent predictor of poor prognosis among these patients.