Diagnosis of minimal hepatic encephalopathy in a tertiary care center from eastern Romania: validation of the psychometric hepatic encephalopathy score (PHES)

Abstract

The psychometric hepatic encephalopathy score (PHES) is frequently used as a "gold standard" for the diagnosis of minimal hepatic encephalopathy (MHE). In Romania, there are currently no widely available tests for the detection of MHE. In this study we aimed to standardize the PHES in a healthy Romanian population and to estimate the prevalence of MHE in a group of Romanian patients with liver cirrhosis. A total of 260 healthy volunteers and 106 patients with liver cirrhosis were included in the study. The five neuropsychological tests comprising the PHES were administered to all enroled subjects. Blood samples for routine tests and serum ammonia were collected. In the healthy volunteer group age and education years were found to be predictors of all tests and gender only in two tests: digit symbol test and serial dotting test. The PHES of the healthy volunteer group was 0,43 ± 1,37 and the cut-off between normal and pathological values was set at -3 points. In the liver cirrhosis group the mean PHES was -2,44 ± 3,41, significantly lower than in the control group (p = 0,001). The estimated prevalence of MHE was 34,7 % (37 patients). In patients with cirrhosis there was a significant correlation between PHES and the severity of the liver disease according to Child-Pugh classification (r = 0,529, p = 0,001) and MELD score (r = -0,525, p = 0,001). According to our results, accurate Romanian PHES norms for the diagnosis of MHE have been developed. MHE was diagnosed in a significant proportion of Romanian patients with liver cirrhosis.

Study of the sleep quality and psychological state of patients with hepatitis B liver cirrhosis

“…Mild defects of MHE cognitive function can sometimes be detected through specific methods such as mental assessment scales or neuropsychiatric testing. Currently, a worldwide consensus on the diagnostic criterion for MHE is absent, and the diagnosis of MHE is difficult . It is common to use more than two sensitive neuropsychological tests.…”

“…Currently, a worldwide consensus on the diagnostic criterion for MHE is absent, and the diagnosis of MHE is difficult. 30,31 It is common to use more than two sensitive neuropsychological tests. This study used NCT-A to preliminarily screen the patients with hepatitis B cirrhosis, which revealed 62.76% MHE patients (214 cases).…”

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