Prevalence of Minimal Hepatic Encephalopathy in Patients with Liver Cirrhosis: A Cross-Sectional, Clinico Epidemiological, Multicenter, Nationwide Study in India: The Predict Study

Abstract

Objectives: The study aimed to assess the prevalence and clinical profile of minimal hepatic encephalopathy (MHE) in patients with cirrhosis using neuropsychological assessment, and to understand the management practices of MHE in the Indian clinical setting. Methods: This cross-sectional, clinico-epidemiological study conducted at 20 sites enrolled liver cirrhosis patients with Grade 0 hepatic encephalopathy according to West Haven Criteria. Patients were subjected to mini-mental state examination (MMSE) and those with a MMSE score of ≥24 were assessed using psychometric hepatic encephalopathy score (PHES). Short Form-36 (SF-36) questionnaire was administered to assess the impact on health-related quality of life (HRQL). Results: Of the 1260 enrolled patients, 1114 were included in the analysis. The mean age was 49.5 years and majority were males (901 [81%]). The prevalence of MHE was found to be 59.7% (665/1114) based on the PHES score of ≤ 5. Alcohol-related liver disease was the most common etiology (482 [43.27%]) followed by viral infection (239 [21.45%]). Past smokers as well as those currently smoking were more likely to have MHE than non-smokers. A significant association was found between tobacco chewing, smoking, alcohol consumption, diabetes, and the presence of MHE. Multivariable analysis revealed smoking as the only parameter associated with MHE. A total of 300 (26.9%) patients were on prophylaxis with lactulose/lactitol or rifaximin. These patients were less likely to have MHE as compared to those, not on prophylaxis (OR 0.67, 95% CI 0.50-0.88; P = 0.005). Conclusions: The disease burden of MHE is quite substantial in patients with cirrhosis with no apparent cognitive defect. Smoking, whether past or current, has significant association with the presence of MHE. Though MHE has been shown to adversely affect HRQL, prophylaxis for MHE is not routinely practiced in the Indian setting. The study has been registered under clinical trials registry of India (CTRI/2014/01/004306). The authors have none to declare.