Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
Am J Gastroenterol. 2023 Dec 1;118(12):2191-2200. doi: 10.14309/ajg.0000000000002251. Epub 2023 Mar 20.
The prevalence of minimal hepatic encephalopathy (MHE), in particular in different subgroups, remains unknown. This study aimed to analyze the prevalence of MHE in different subgroups to identify patients at high risk and to pave the way for personalized screening approaches.
In this study, data of patients recruited at 10 centers across Europe and the United States were analyzed. Only patients without clinical signs of hepatic encephalopathy were included. MHE was detected using the Psychometric Hepatic Encephalopathy Score (PHES, cut-off < or ≤-4 depending on local norms). Clinical and demographic characteristics of the patients were assessed and analyzed.
In total, 1,868 patients with cirrhosis with a median model for end-stage liver disease (MELD) of 11 were analyzed (Child-Pugh [CP] stages: A 46%, B 42%, and C 12%). In the total cohort, MHE was detected by PHES in 650 patients (35%). After excluding patients with a history of overt hepatic encephalopathy, the prevalence of MHE was 29%. In subgroup analyses, the prevalence of MHE in patients with CP A was low (25%), whereas it was high in CP B or C (42% and 52%). In patients with a MELD score <10, the prevalence of MHE was only 25%, but it was 48% in patients with a MELD score ≥20. Standardized ammonia levels (ammonia level/upper limit of normal of each center) correlated significantly, albeit weakly with PHES (Spearman ρ = -0.16, P < 0.001).
The prevalence of MHE in patients with cirrhosis was high but varied substantially between diseases stages. These data may pave the way for more individualized MHE screening approaches.
轻微型肝性脑病（MHE）的流行率，尤其是在不同亚组中的流行率尚不清楚。本研究旨在分析不同亚组中 MHE 的流行率，以确定高危患者，并为个性化筛查方法铺平道路。
本研究分析了在欧洲和美国 10 个中心招募的患者数据。仅纳入无肝性脑病临床症状的患者。使用心理测量性肝性脑病评分（PHES，根据当地标准，截断值<或≤-4）检测 MHE。评估并分析患者的临床和人口统计学特征。
共分析了 1868 例肝硬化患者，中位终末期肝病模型（MELD）为 11（Child-Pugh [CP] 分级：A 级 46%，B 级 42%，C 级 12%）。在总队列中，650 例患者（35%）通过 PHES 检测到 MHE。排除有显性肝性脑病病史的患者后，MHE 的患病率为 29%。在亚组分析中，CP A 患者 MHE 的患病率较低（25%），而 CP B 或 C 患者的患病率较高（42%和 52%）。MELD 评分<10 的患者中，MHE 的患病率仅为 25%，但 MELD 评分≥20 的患者中，MHE 的患病率为 48%。标准化的氨水平（每个中心的氨水平/正常上限）与 PHES 显著相关，尽管相关性较弱（Spearman ρ=-0.16，P<0.001）。
肝硬化患者中 MHE 的患病率较高，但在疾病阶段之间差异很大。这些数据可能为更个体化的 MHE 筛查方法铺平道路。
