Laboratory of Gastro-hepatology Research, Hospital de Pediatría and Gastroenterology Department, CMN Siglo XXI, Mexican Institute of Social Security, Mexico.
Minimal hepatic encephalopathy (MHE) affects more that 30% of patients with cirrhosis, and it has been suggested that despite no recognizable clinical symptoms of neurological abnormalities, it might affect the health-related quality of life (HRQL); however, this fact remains controversial. The aim of our study was to evaluate the prevalence of MHE and HRQL in patients diagnosed with decompensated cirrhosis.
Patients with liver cirrhosis were selected independent of the etiology of the disease. All patients underwent a complete clinical history, and only patients with decompensated hepatic cirrhosis were included. Psychometric tests were applied to evaluate the presence of MHE along with the Chronic Liver Disease Questionnaire (CLDQ). Appetite was measured by verbal and visual analogue scales.
One hundred twenty five patients were included with median age of 56.0 (14) years. They were classified according to the Child-Pugh index as A, (n=56), B, (n=51), and C (n=18). Prevalence of MHE was 44.0% (n=55). In patients with MHE, a significant reduction was observed in domains of activity [3.3(2.0) vs 4.8(2.8)), fatigue [3.2(2.0) vs 3.9(2.3)], systemic symptoms [3.8(2.0) vs 4.8(1.7)], emotional function [3.6(1.9) vs 4.0(1.9)] and global scoring [3.7(1.7) vs 4.3(1.8)] when compared with non-MHE patients (n=70). Twenty two percent of the patients with MHE reported little appetite compared with 11% in the non-MHE group.
The results suggest that MHE and a reduction in appetite are associated with deterioration in HRQL in patients with decompensated cirrhosis.