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Minimal hepatic encephalopathy runs a fluctuating course: results from a three-year prospective cohort follow-up
1Department of Gastroenterology and Hepatology, Singapore General Hospital, Outram Road, Singapore 169608. tan.hui.hui@sgh.com.sg
Introduction:
Minimal hepatic encephalopathy (mHE) has been reported in up to 84 percent of cirrhotics. The natural history of mHE has not been well-described. We designed a three-year prospective cohort study to determine the prevalence and natural history of mHE among cirrhotic patients.
Methods:
The patient cohort comprising 62 consecutive outpatients with cirrhosis were assessed at baseline and followed-up with a repeat assessment three years later. The assessments include: (1) Neuropsychometric analysis (digit-symbol substitution test, block-design test, number-connection test A); (2) Clinical, biochemical assessment; and (3) Quality of life (QOL) assessment (abbreviated sickness impact profile).
Results:
Baseline characteristics were: age 52.9 +/- 11.0 years; Child's A:B:C was 46:14:2. mHE was detected in 33.9 percent of the cohort. Older age, a higher Child-Pugh score and female gender were independently associated with mHE. mHE was associated with a poorer QOL. Follow-up assessment three years later showed that seven patients had died, while six were lost to follow-up; these patients had significantly higher baseline Child's scores. Of the remaining patients, 36/49 (73 percent) agreed to a repeat evaluation. In this group, none had mHE. QOL remained impaired despite the resolution of mHE.
Conclusion:
It has been shown for the first time that mHE can revert to a normal state in a significant proportion of patients with well-compensated cirrhosis.
Insights
Minimal hepatic encephalopathy (mHE) can resolve in many well-compensated cirrhosis patients over three years. However, quality of life remains impaired even after mHE remission.
Area of Science:
- Hepatology
- Neurology
- Clinical Research
Background:
- Minimal hepatic encephalopathy (mHE) affects up to 84% of cirrhosis patients.
- The natural history and long-term outcomes of mHE are not well-understood.
Purpose of the Study:
- To investigate the prevalence and natural history of mHE in cirrhosis patients.
- To assess the reversibility of mHE and its impact on quality of life over three years.
Main Methods:
- A three-year prospective cohort study of 62 outpatients with cirrhosis.
- Assessments included neuropsychometric tests, clinical/biochemical evaluations, and quality of life (QOL) surveys.
Main Results:
- 33.9% of patients had mHE at baseline, associated with older age, higher Child-Pugh score, and female gender.
- After three years, 73% of eligible patients showed mHE resolution, with no deaths or losses to follow-up in this subgroup.
- Despite mHE resolution, patients reported persistent QOL impairment.
Conclusions:
- Minimal hepatic encephalopathy (mHE) can spontaneously revert in a significant number of patients with well-compensated cirrhosis.
- Resolution of mHE does not guarantee full recovery of quality of life in these patients.
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