Sahaj Rathi1, Madhu Chopra1, Gourdas Chouduri2, Praveen Sharma3, Kaushal Madan4, Mohinish Chhabra5, Ramesh R Rai6, Anurag Govil7, Asokananda Konar8, Mahesh Goenka9, Manoj Agarwal10, Jayanta Mukherjee11, Vinay Thorat12, Sanjay Salunkhe13, Philip Abraham14, Aabha Nagral15, Ajay Jhaveri15, Naresh Bhat16, Joy Varghese17, Arun R S18, Deevaguntla C Reddy19, Radha K Dhiman1. 1. Postgraduate Institute of Medical Research, Chandigarh, India. 2. Fortis Memorial Research Institute, Gurgaon, India. 3. Sir Ganga Ram Hospital, New Delhi, India. 4. Institute of Digestive and Hepatobiliary Sciences, Medanta - The Medicity, Gurgoan, India. 5. Fortis Hospital, Mohali, India. 6. Rai Specialty Care Centre, Jaipur, India. 7. Santokba Durlabhji Memorial Hospital, Jaipur, India. 8. Peerless Hospital and BK Roy Research Center, Kolkata, India. 9. Appollo Gleneagles Hospital, Kolkata, India. 10. Bellevue Clinic, Kolkata, India. 11. ILS Hospital, Kolkata, India. 12. Poona Hospital and Research Center, Pune, India. 13. Inamdar Multispeciality Hospital, Pune, India. 14. PD Hinduja Hospital and Medical Research Centre, Mumbai, India. 15. Nagral Clinic, Mumbai, India. 16. Columbia Asia Referral Hospital, Bangalore, India. 17. Global Hospital and Health City, Chennai, India. 18. Madras Medical Mission, Chennai, India. 19. Yashoda Hospital, Hyderabad, India.
Abstract
BACKGROUND: The study aimed at assessing the prevalence and clinical profile of minimal hepatic encephalopathy (MHE) in patients with cirrhosis using neuropsychological assessment and at understanding the management practices of MHE in the Indian clinical setting. METHODS: This cross-sectional, clinicoepidemiological 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 and those with a score of ≥24 were assessed using psychometric hepatic encephalopathy score. Short Form-36 questionnaire was administered to assess the impact on health-related quality of life. 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 psychometric hepatic encephalopathy 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 nonsmokers. 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 (odds ratio, 0.67; 95% confidence interval, 0.50-0.88; P = 0.005). CONCLUSION: 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. Although MHE has been shown to adversely affect quality of life, 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).
BACKGROUND: The study aimed at assessing the prevalence and clinical profile of minimal hepatic encephalopathy (MHE) in patients with cirrhosis using neuropsychological assessment and at understanding the management practices of MHE in the Indian clinical setting. METHODS: This cross-sectional, clinicoepidemiological 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 and those with a score of ≥24 were assessed using psychometric hepatic encephalopathy score. Short Form-36 questionnaire was administered to assess the impact on health-related quality of life. 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 psychometric hepatic encephalopathy 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 nonsmokers. 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 (odds ratio, 0.67; 95% confidence interval, 0.50-0.88; P = 0.005). CONCLUSION: 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. Although MHE has been shown to adversely affect quality of life, 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).
Entities:
Keywords:
ALD, alcohol-related liver disease; CI, confidence interval; DST, Digit Symbol Test; FCT, figure connection test; HE, hepatic encephalopathy; HRQL, health-related quality of life; MCS, mental component summary; MELD, model for end-stage liver disease; MHE, minimal hepatic encephalopathy; MMSE, mini-mental state examination; NCT, number connection test; PCS, physical component summary; PHES; PHES, psychometric hepatic encephalopathy score; SF-36, Short Form-36; cirrhosis; covert hepatic encephalopathy; hepatic encephalopathy; lactulose; minimal hepatic encephalopathy; quality of life
Authors: I J Hartmann; M Groeneweg; J C Quero; S J Beijeman; R A de Man; W C Hop; S W Schalm Journal: Am J Gastroenterol Date: 2000-08 Impact factor: 10.864
Authors: P Amodio; F Del Piccolo; P Marchetti; P Angeli; R Iemmolo; L Caregaro; C Merkel; G Gerunda; A Gatta Journal: Hepatology Date: 1999-06 Impact factor: 17.425
Authors: J S Meyer; G M Rauch; K Crawford; R A Rauch; S Konno; H Akiyama; Y Terayama; A Haque Journal: Int J Geriatr Psychiatry Date: 1999-12 Impact factor: 3.485
Authors: Peter Ferenci; Alan Lockwood; Kevin Mullen; Ralph Tarter; Karin Weissenborn; Andres T Blei Journal: Hepatology Date: 2002-03 Impact factor: 17.425