Abstract
Background and aimsMinimal hepatic encephalopathy (MHE) may impair driving performance and adversely disturbs quality of life. Most drivers with chronic liver disease are not routinely screened for MHE and stay untreated due to the deficiency of standardization of normal values, simple tools, and skills to carry out tests. This study evaluated the usefulness of psychometric tests and critical flicker frequency (CFF) to diagnose MHE among screened drivers with chronic liver disease in Assiut, a city in Upper Egypt.Patients and methodsA total of 100 drivers with chronic liver disease were screened for MHE. Routine investigations were carried out for all. Psychometric tests including number connection tests A, symbol digits test and CFF testing were applied for them. mini mental state examination questionnaires and Beck’s inventory were carried out for those diagnosed as having MHE.ResultsMHE was found among 40%, with 20 (50%) in Child’s A, 11 (27.5%) in Child’s B, and nine (22.5%) in Child’s C cirrhosis (P=0.027), and 45% of those with MHE had bad driving history. Twelve (12%) patients had abnormal psychometric tests. The sensitivity and specificity of receiver operating characteristic curves for CFF in the diagnosis of MHE was 100%, with a cutoff of less than or equal to 38.5 Hz, and the area under the curve was 1.00 (95% confidence interval, 0.964–1.00) (P<0.0001). There was significant reverse correlation between CFF and Child–Pugh score (r=‒0.271, P=0.030).ConclusionOur data revealed a high prevalence of MHE (40%) among drivers with liver cirrhosis. The CFF test is a simple, accurate, and reliable test for diagnosis of MHE, with no age or literacy requirement. Therefore, we suggest to include the CFF test in screening of drivers with chronic liver disease for early discovery and proper management.
Highlights
Minimal hepatic encephalopathy (MHE) is a subtle form of hepatic encephalopathy (HE); it is associated with increased mortality, risk of hospitalization, impairment of quality of life, and caregiver burden
Our case–control study recruited 100 patients with known chronic liver disease (77% HCV, 17% HBV, and 6% coinfection) and age and sex matched individuals were included as a control group; the Discussion MHE negatively affects quality of life related to health (HRQOL); complex activities including attention, information processing, and psychomotor expertise
A combination of bleeding disorders, sepsis, and hepatic dysfunction has been noted as contributing factors to this worse prognosis [20].Age and educational status are recognized widely as being associated to neuropsychological test results and normal values of healthy controls for age and Conclusion Our data revealed a high prevalence of MHE (40%) among Egyptian drivers with liver cirrhosis
Summary
Minimal hepatic encephalopathy (MHE) is a subtle form of hepatic encephalopathy (HE); it is associated with increased mortality, risk of hospitalization, impairment of quality of life, and caregiver burden. Further studies have been carried out, and there is growing evidence of compromised driving abilities in cirrhotic patients who meet the criteria for MHE diagnosis. Most drivers with chronic liver disease are not routinely screened for MHE and stay untreated due to the deficiency of standardization of normal values, simple tools, and skills to carry out tests. This study evaluated the usefulness of psychometric tests and critical flicker frequency (CFF) to diagnose MHE among screened drivers with chronic liver disease in Assiut, a city in Upper Egypt. Patients and methods A total of 100 drivers with chronic liver disease were screened for MHE. We suggest to include the CFF test in screening of drivers with chronic liver disease for early discovery and proper management
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