Review article: the burden of hepatic encephalopathy

Abstract

Hepatic encephalopathy, a challenging complication of advanced liver disease, occurs in approximately 30-45% of patients with cirrhosis and 10-50% of patients with transjugular intrahepatic portosystemic shunt, while minimal hepatic encephalopathy affects approximately 20-60% of patients with liver disease.Although the total direct and indirect costs of hepatic encephalopathy have not been formally quantified, data from the Healthcare Cost and Utilization Project suggest that hepatic encephalopathy-related hospitalizations are associated with substantial costs.In 2003, there were over 40 000 patients hospitalized in the United States for a primary diagnosis of hepatic encephalopathy, resulting in total charges of approximately $932 million. Furthermore, trends over the past 10 years suggest that the burden of hepatic encephalopathy is increasing, as indicated by increases in hospital admissions and higher charges per stay.Because of inconsistencies in coding for hepatic encephalopathy, the prevalence and cost data from this data source are believed to significantly underestimate the true burden of hepatic encephalopathy. In addition, expenditures for physician fees and out-patient care, as well as indirect costs attributable to lost work days and decreased productivity, have not been quantified.Thus, there is need for future studies to more accurately define the burden of hepatic encephalopathy, including minimal hepatic encephalopathy.

Minimal Hepatic Encephalopathy Impairs Quality of Life

“…Frequency of MHE increases as severity of liver dysfunction increases. 7,10,12,[16][17][18] MHE predicts the development of overt HE and also adversely affects survival as shown by several studies. 7,10,18,[84][85][86][87] Das et al 10 studied the progression of MHE to overt HE in relation to severity of liver dysfunction and found that overt HE were more frequent in patients with MHE and Child-Turcotte-Pugh (CTP) score >6.…”

“…10 These patients pose a significant burden to their care givers depending on the severity of cognitive dysfunction. 2,12 Considering all these facts together, early detection and treatment of MHE is warranted and recommended. 2 This review focuses on MHE and its effect on daily functioning including driving skills, sleep disturbances and HRQOL in an individual.…”

“…83 Impact of MHE on daily life is enormous. 12 Diminished work performance and lost wages also entail substantial costs. Socioeconomic implications of the profound negative effects of MHE on functioning in the workplace are significant.…”

“…Socioeconomic implications of the profound negative effects of MHE on functioning in the workplace are significant. 12 …”

Management of Overt Hepatic Encephalopathy

“…Data in other countries are lacking, hence it causes a huge burden financially to the patient and society. 3 The West Haven Criteria are most often used to grade HE, with scores ranging from I-IV (IV being coma). However, it is a challenge to diagnose patients with minimal hepatic encephalopathy (MHE) or grade 1 HE; so it might be practical to combine these entities and name them covert HE for clinical use and overt HE to patients with grade II to IV.…”