Screening of subclinical hepatic encephalopathy

Subclinical hepatic encephalopathy adversely affects daily functioning. The aim of this study was to determine which elements of daily life have predictive value for subclinical hepatic encephalopathy.

The study was performed in 179 outpatients with liver cirrhosis. Subclinical hepatic encephalopathy was diagnosed using psychometric tests with normal values corrected for age (Number Connection Test A and the Digit Symbol Test) and automated analysis of the electroencephalogram (EEG). Daily functioning was measured with the Sickness Impact Profile (SIP), a quality of life questionnaire, containing 136 statements. Patients with and without SHE were compared for differences in response to all statements by univariate analysis, and subsequently by multivariate analysis of potential discriminating statements.

SHE was diagnosed in 48 patients (27%). Thirty-six statements were significantly more often true for patients with subclinical hepatic encephalopathy. Multivariate analysis showed that five statements of the SIP, related to alertness, sleep and rest, fine motor skills and work, have independent predictive power for subclinical hepatic encephalopathy.

Combining these statements predictive for subclinical hepatic encephalopathy with patient characteristics enables physicians to assess the probability of subclinical hepatic encephalopathy in the individual cirrhotic patient at the bedside or in the outpatient clinic.