Martens, E. (Emily) (2019) Prevalence of and risk factors associated with Minimal Hepatic Encephalopathy in patients with liver cirrhosis. thesis, Medicine.
Full text available on request.Abstract
Background & aims: Minimal hepatic encephalopathy (MHE) is a frequently underdiagnosed neuropsychiatric complication of liver cirrhosis, reported to severely affect daily functioning, driving skills and progression to overt HE. Epidemiological data on this sub form of HE are scarce due to the lack of clinical appearance and no uniform diagnostic criteria for MHE. This study aims to characterize the prevalence of MHE in cirrhotic outpatients of a large peripheral hospital in the east of the Netherlands (Medical Spectrum Twente), and determine possible factors related to the disorder to help identify subgroups with a higher risk of MHE. Since previous studies have demonstrated diminished quality of life (HRQoL) due to MHE, we aimed to determine this effect of MHE on HRQoL. Methods: In this cohort study all consecutive patients with liver cirrhosis, presenting between 23 August till 24 October on the outpatient clinic were evaluated for study participation. Patients underwent testing for MHE, including PHES and CFF. Various demographic, clinical and laboratory parameters were included in univariate analysis. Moreover, status of healthrelated quality of life was obtained by utilizing a general questionnaire (SIP-68) and these were subsequently analysed. Results: A total of 116 consecutive cirrhotic patients was screened for enrollment, of which 51 (43.9%) were found eligible. MHE was identified in 43.1% (n=22) of the cirrhotic patients. The prevalence increased incrementally with the severity of liver cirrhosis (CTP-A/ B/ C; 40%, 58%, 100%). Univariate analysis showed that cirrhosis of alcohol genesis (P=0.034) and ascites stage (P=0.003) were associated with the presence of MHE. Overall HRQoL did not differ between groups (P=0.600), but PHES subtest DST was associated with all the dimensions of HRQoL. Of the performed tests, PHES showed greatest contribution to MHE testing, whereas a cut-off of 39.0 Hz for CFF resulted into testing beyond the level of MHE; more like HE1. Conclusions: cirrhotic patients have a high overall prevalence of MHE (43.1%), which increases incrementally with the severity of liver disease defined by CTP. Moreover, the occurrence of MHE was associated with liver cirrhosis due to previous alcohol abuse, as well as to the stage of ascites. While other studies have shown that the presence of MHE adversely affects HRQoL, ours is one of the few studies showing contrasting results demonstrating similar HRQoL in patients with and without MHE. Further research is strongly recommended in order to achieve better understanding of MHE and accomplishing uniform diagnostic criteria.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Dr. M.M.J. Guichelaar MD. PhD and Department of Gastroenterology and Hepatology, Medical Spec |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:46 |
| Last Modified: | 25 Jun 2020 10:46 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/731 |
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