Minimal hepatic encephalopathy amongst chronic liver disease patients in a hospital: Need for cognitive evaluation?

Abstract

Background: Minimal Hepatic Encephalopathy (MHE) reflects the earliest stage of HE, its identification is important to retard its progression.
Objectives: To determine the prevalence of MHE amongst patients with chronic liver disease (CLD) in a tertiary hospital in Lagos State.
Materials and Methods: Following ethical approval, a record form was used to evaluate the clinical and laboratory features of 65 consecutive patients with CLD, and 65 controls. A MMSE and two neuropsychometric tests: NCT-A and NCT-B were administered to all subjects. EEG was done on 32 patients and venous ammonia assays carried out on all subjects. MHE was present if there are two abnormal neuropsychometric tests, or one abnormal neuropsychometric test with an abnormal EEG. A p value of <0.05 was significant.
Results: The mean age of the patients was 39.66± 9.86years. The types of CLD identified were chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. The mean time for the NCT-A was 37.18secs and 62.02secs, and for NCT-B was 58.88secs and 135.51secs, each for the controls and patients respectively (p- 0.000). 34.4% of the patients had abnormal EEG findings. Prevalence of MHE was 43.1%. Prevalence of MHE increased according to the Child-Pugh class (p= 0.008). The mean venous ammonia level was 72.35μg/ dl for patients with MHE, and 52.00μg/dl for those without MHE (p - 0.057).
Conclusion: MHE was present in less than half of the patients, correlated with the severity of CLD, but not with ammonia levels. We need to set up routine cognitive evaluation for CLD patients.

Keywords: Ammonia, Hepatic Encephalopathy, Liver cirrhosis, Chronic Hepatitis, Hepatocellular carcinoma