Evaluation of the prevalence of minimal hepatic encephalopathy in patients with compensated cirrhosis

In this study 50 cases of compensated cirrhotics were evaluated for presence of Minimal Hepatic Encephalopathy. • In this study we defined minimal hepatic encephalopathy based on psychometric analysis,13 by way of the Number Connection Test, since earlier studies have proved that the abnormal psychometric test as one of the earliest manifestation of minimal hepatic encephalopathy. Based on the NCT this study found a prevalence of 38% MHE amongst the compensated cirrhotics studied • Minimal hepatic encephalopathy was defined in our study based on the prolonged time taken to complete the NCT and/or Electroencephalography changes/ or a combination of electroencephalography and serum ammonia rise/ or a combination of serum ammonia and number connection test. • High serum ammonia alone was not taken as indicative of minimal hepatic encephalopathy as it was found by many studies not to correlate with the presence of Minimal hepatic encephalopathy. • The total percentage of cases diagnosed as having minimal hepatic encephalopathy in our study using the above criteria was 38% • Out of the 19 patients tested positive for minimal hepatic encephalopathy 16 were males and 3 were females • In a study conducted by Quero et.al in Holland13 about MHE in cirrhotics with NCT and EEG, showed a prevalence of 24%. Correlation was done using arterial ammonia and PET scan. Magnetic Resonance Spectroscopy was also used for correlation. • In a German study47 published in the Journal of Hepatology in 1998 July, pages 45 to 49 volume 28 No.1 the prevalence of MHE was estimated to be 45% by various psychometric tests including the Number Connection Test thus establishing it as a simple bedside tool for assessment of the presence of MHE in the cirrhotics • In a study conducted by Amodio et al in Italy46 it was found that using the NCT and Line tract test the prevalence of Minimal Hepatic encephalopathy was estimated to be 28% but estimates by spectral EEG was only 10% • In comparison, our study shows a prevalence of minimal hepatic encephalopathy in the group by number connection test to be 34% and that by electroencephalogram to be 6%. CONCLUSIONS : The prevalence of Minimal Hepatic Encephalopathy in compensated cirrhotics in our study is 38%. There is no significant difference in the prevalence rate between males and females. (38% Vs 37%) Number Connection Test and other psychometric tests are useful as bedside tools in estimating Minimal Hepatic Encephalopathy. Psychometric test positivity does not correlate well with Electro-encephalographic changes in the diagnosis of Minimal Hepatic Encephalopathy. Evaluating a cirrhotic patient for MHE is essential for its impact on day to day functionality like driving, operating machineries and social interaction apart from other activities like driving