Psychomotor Speed From Minimal Hepatic Encephalopathy Testing Is Associated With Physical Frailty in Patients With Advanced Chronic Liver Disease

Physical frailty and minimal hepatic encephalopathy (MHE) are common in advanced chronic liver disease (AdvCLD). Although the Psychometric Hepatic Encephalopathy Score is used for MHE diagnosis, its complexity limits routine use. The Stroop EncephalApp (StE) offers a simpler method for MHE diagnosis. We aimed to investigate the association between MHE using the StE and physical frailty by the Liver Frailty Index (LFI), in patients with AdvCLD.

This multicenter study analyzed data from patients with AdvCLD awaiting liver transplantation. Patients were categorized into 2 groups based on the presence or absence of MHE and compared using the LFI and its components. To identify factors influencing the various StE modalities and MHE diagnosis, we used the Spearman rank correlation coefficient and logistic regression models.

Of the 267 patients, 73% were diagnosed with MHE, and 18% of the total cohort were classified as frail. Patients with MHE demonstrated poorer LFI scores and were more likely to be categorized as prefrail or frail. Notably, there was a significant correlation between StE time modalities, especially off-time, and the LFI score (rho = 0.438, P < 0.001). Furthermore, multivariable analyses indicated that the LFI was independently associated with MHE (OR 2.41, 95% CI 1.52-3.82).

The findings suggest that the LFI score in this population reflects its ability to capture the crucial role of psychomotor speed, particularly evident in off-time performance, thus connecting neurocognitive and physical function. Further research is warranted to investigate the effectiveness of interventions targeting cognitive and physical impairments to enhance clinical outcomes in patients with AdvCLD.