Detecting Minimal Hepatic Encephalopathy in an Endemic Country for Hepatitis B: The Role of Psychometrics and Serum IL-6

Abstract

Background & AimsIt remains unknown what the prevalence of minimal hepatic encephalopathy is in Taiwan, a highly endemic country for chronic viral hepatitis infection. It is also unclear whether abnormal serum cytokine levels can be indicative of the presence of minimal hepatic encephalopathy. We aimed to standardize the tests of psychometric hepatic encephalopathy score and predictive value of proinflammatory cytokines in minimal hepatic encephalopathy in Taiwan.Methods180 healthy subjects and 94 cirrhotic patients without a history of overt hepatic encephalopathy from a tertiary center were invited to participate in this cross-sectional study. Blood sampling for determination of serum levels of interleukin 6 and 18 and tumor necrosis factor-α was performed. Based on the normogram of psychometric hepatic encephalopathy score from healthy volunteers, patients with minimal hepatic encephalopathy were identified from the cirrhotic patients using the criterion of a psychometric hepatic encephalopathy score less than −4.ResultsIn the healthy subjects, age and education were predictors of subtests of psychometric hepatic encephalopathy score. Minimal hepatic encephalopathy was identified in 27 (29%) cirrhotic patients. Serum interleukin 6 level (OR = 6.50, 95% CI = 1.64–25.76, P = 0.008) was predictive of the presence of minimal hepatic encephalopathy after multivariate analysis.ConclusionsThe psychometric hepatic encephalopathy score can be a useful tool for detecting patients with minimal hepatic encephalopathy in Taiwan and around one third of cirrhotic outpatients fulfill this diagnosis. A high serum interleukin 6 level is predictive of the presence of minimal hepatic encephalopathy.

Increased serum interleukin‐6, not minimal hepatic encephalopathy, predicts poor sleep quality in nonalcoholic cirrhotic patients

“…Our group has conducted a validation study using PHES to detect MHE in Taiwan. A PHES < −4 was considered diagnostic of MHE …”

Electroencephalogram Abnormalities in Very Young Children with Acute Hepatitis A Infection: A Cross-Sectional Study

“…Furthermore, HE development is suggested to be related to impaired connectivity between various brain regions (26). Roles have been proposed for inflammatory cytokines; IL-1, TNF-a, and IL-6 (6,27), concomitant Helicobacter pylori infection (28), hyponatremia (7), and high serum hyaluronic acid levels (29) as factors triggering the development and progression of HE.…”

“…HE has been described in association with various hepatitis viruses including hepatitis C (HCV), hepatitis B (HBV), hepatitis E (HEV), and hepatitis A (HAV) (6)(7)(8)(9)(10)(11). Thus, overt HE has been noted in 7.4% of patients with HAV infection (11).…”

Reversibility of minimal hepatic encephalopathy following liver transplantation in Egyptian cirrhotic patients

“…These are the same tests used by Wang et al[3] and Tsai et al[15] to diagnose MHE. They have high sensitivity and specificity and are easily applied with no difficulty in their score calculation[15,16].…”

“…These are the same tests used by Wang et al[3] and Tsai et al[15] to diagnose MHE. They have high sensitivity and specificity and are easily applied with no difficulty in their score calculation[15,16]. These tests monitor changes in attention, motor speed and executive functions, which are the first to improve in the post transplantation period[3,16].…”