MINIMAL HEPATIC ENCEPHALOPATHY IN ALCOHOLIC CIRRHOSIS

CORRESPONDING AUTHOR:
Dr. Rajasekaran Durai,
26/25, New secretariat Colony,
2nd street,
Kilpauk,
Chennai-600010.
E-mail: rasekar50@yahoo.com

ABSTRACT: BACKGROUND: Minimal hepatic Encephalopathy (MHE) has severe and important health implications which affects the quality of life as well as the survival of patients with liver disease. Psychometric hepatic encephalopathy score (PHES) has been validated for diagnosis of MHE.

AIM OF THE STUDY: To detect the prevalence of minimal hepatic encephalopathy (MHE) in alcoholic cirrhosis patients and to compare the patterns of alcohol consumption in patients with MHE to those without MHE (NON-MHE). SETTINGS AND DESIGN: The study was conducted in Chettinad Hospital and Research Institute, Kelambakkam, a 1000 bedded academic medical centre in South India. This was a prospective observational study. MATERIALS AND METHODS: 25 alcoholic cirrhotic patients without overt hepatic encephalopathy and 20 patients who are alcoholics without any liver disease were given the five tests of PHES (Number connection test A (NCT-A),  Figure connection test (FCT),  Line Tracing Test (LTT),  Circle Dotting Test (CDT) and Digit Symbol Test (DST))  in a quiet well lit room. Individual performance test values more than 1 S.D from the mean were considered abnormal. Based on the nomogram of healthy volunteers, the patients were classified as having MHE when they had impaired performance in ≥2 tests. RESULTS: There was no significant difference in the baseline characteristics between the two groups. In liver cirrhosis patients, MHE was diagnosed in 7 patients (28%).  In NCT-A 28% (n=7) did abnormally, in FCT 16% (n=4),  in LTT,  CDT and DST 24% (n=6), 12% (n=3),  24% (n=6) respectively had impaired performance. NCT-A and LTT showed statistically significant difference between the study group.  Hence these 2 tests were considered to have high sensitivity for screening of MHE (p-0.003, p-0.004). The proportion of patients with MHE increased as the duration of alcohol consumption increased. 73.3% of those with MHE had more than 10 years of alcohol consumption. CONCLUSION: The prevalence of MHE in alcoholic cirrhosis in our population was 28% which is close to that reported from other populations. Age and education had major influence on the overall test performance and it needs to be taken into consideration while interpretation of test results. The greater the duration of alcohol intake there was an increase in the occurrence of Minimal hepatic encephalopathy. Those even with harmful drinking pattern for longer duration are prone to develop DCLD and complications of hepatic encephalopathy.

KEYWORDS: MHE, PHES, Minimal Hepatic Encephalopathy, Psychometric Hepatic Encephalopathy Score, Alcoholic cirrhosis, Cognitive impairment.