Role of minimal hepatic encephalopathy in road traffic accidents

Abstract

BackgroundThe term minimal hepatic encephalopathy (MHE) is defined as encephalopathy that does not lead to clinically overt cognitive dysfunction but can have an impact on quality of life, risk of involvement in road traffic accidents, and ability to function in daily life.ObjectiveTo identify the incidence of minimal hepatic encephalopathy in patients actively involved in a road traffic accident and its role in the increased incidence of road traffic accidents.Patients and methodsWe included 74 patients presented in road traffic accidents (drivers, history of fall, pedestrians whom accidents occur during crossing the road) with clinically proven hepatic cirrhosis, without clinical manifestation of hepatic encephalopathy (HE). Thorough history taking, clinical examinations, routine laboratory investigations, serum IL-6 and ammonia in blood were done. Diagnosis of MHE is based on psychometric hepatic encephalopathy score (PHES) which includes digit symbol test (DST), number connection test-A (NCT-A), number connection test-B (NCT-B), serial dotting test (SDT), and line drawing test (LDT).ResultsThe mean age was 52.0 ± 7.47 in MHE patients. Most of the MHE patients were males. Most of the patients with MHE were working other jobs and were not drivers (63.2% vs 36.8%). MHE was observed in 19 patients (25.7%). Albumin, interleukin-6 (IL-6), and ammonia were statistically significantly different between both groups.ConclusionMinimal hepatic encephalopathy (MHE) was observed in 25.7% of patients which points that we must give attention in the screening of MHE as road traffic accident is considered the main cause of mortality in our community with high incidence of liver disease.