Author information

• ¹Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
• ²Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
• ³Department of Medicine, University of Padova, Padova, Italy.
• ⁴Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
• ⁵Department of Gastroenterology and Hepatology, Hospital of South West Jutland, Esbjerg, Denmark.
• ⁶Department of Medicine I, University Hospital Schleswig-Holstein, Lübeck, Germany.
• ⁷Clinic for Neurology, Hannover Medical School, Hannover, Germany.
• ⁸Department of Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA.
• ⁹Department of Internal Medicine IV, Jena University Hospital, Jena, Germany.
• ¹⁰First Department of Internal Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
• ¹¹Service d'hépato-gastroentérologie, Sorbonne Université, Hôpital Pitié-Salpêtrière Assistance Publique Hôpitaux de Paris, Paris, France.
• ¹²Department of Medicine, Diakonie Hospital Jung-Stilling, Siegen, Germany.
• ¹³Chronobiology Section, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.

Abstract

Introduction: The prevalence of minimal hepatic encephalopathy (MHE), in particular in different subgroups, remains unknown. This study aimed to analyze the prevalence of MHE in different subgroups to identify patients at high risk and to pave the way for personalized screening approaches.

Methods: In this study, data of patients recruited at 10 centers across Europe and the United States were analyzed. Only patients without clinical signs of hepatic encephalopathy were included. MHE was detected using the Psychometric Hepatic Encephalopathy Score (PHES, cut-off < or ≤-4 depending on local norms). Clinical and demographic characteristics of the patients were assessed and analyzed.

Results: In total, 1,868 patients with cirrhosis with a median model for end-stage liver disease (MELD) of 11 were analyzed (Child-Pugh [CP] stages: A 46%, B 42%, and C 12%). In the total cohort, MHE was detected by PHES in 650 patients (35%). After excluding patients with a history of overt hepatic encephalopathy, the prevalence of MHE was 29%. In subgroup analyses, the prevalence of MHE in patients with CP A was low (25%), whereas it was high in CP B or C (42% and 52%). In patients with a MELD score <10, the prevalence of MHE was only 25%, but it was 48% in patients with a MELD score ≥20. Standardized ammonia levels (ammonia level/upper limit of normal of each center) correlated significantly, albeit weakly with PHES (Spearman ρ = -0.16, P < 0.001).

Discussion: The prevalence of MHE in patients with cirrhosis was high but varied substantially between diseases stages. These data may pave the way for more individualized MHE screening approaches.