Minimal hepatic encephalopathy runs a fluctuating course: results from a three-year prospective cohort follow-up study

Tan HH, Lee GH, Thia KTJ, Ng HS, Chow WC, Lui HF
Correspondence: Dr Hui-Hui Tan, tan.hui.hui@sgh.com.sg

ABSTRACT
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.

Keywords: cirrhosis, hepatic encephalopathy, minimal hepatic encephalopathy
Singapore Med J 2009; 50(3): 255-260