Roy Akash, Bhattad Utkarsh, Ranjan Vivek, Chakraborty Shardhya, Tewari Awanish, Sonthalia Nikhil, Ghoshal Uday Chand, Goenka Mahesh K
Department of Gastroenterology, Institute of Gastrosciences and Liver Transplantation, Apollo Multispeciality Hospitals, Kolkata, India.
Eur J Gastroenterol Hepatol. 2025 May 1;37(5):612-618. doi: 10.1097/MEG.0000000000002924. Epub 2025 Jan 21.
Cognitive impairment in cirrhosis is driven by multiple influencers. Those with cognitive impairment have greater traffic accidents and violations. While the presence of minimal hepatic encephalopathy has been associated with poor driving skills, studies show conflicting results and variable associations with regard to accidents.
In a prospective study of stable outpatients with cirrhosis without a recent history of overt hepatic encephalopathy (OHE) (<3 months), we assessed, the overall practice of driving, recent (<1 month) self-reported accidents, and factors associated with driving accidents.
Of 433 patients, 147 (33.9%) [age, 55 (46-61) years, 97.9% males, 29.9% alcohol-related, 13.6% prior OHE, MELD 11 (10-16), lactulose use 45.5%, rifaximin use 23.1%] reported recent driving (≤1 month), of whom 22 (14.9%) had recent driving accidents. Those with reported accidents had a higher history of prior OHE (31.8 vs. 10.5%, P < 0.05) and lower sodium [131 (129-134) vs. 134 (132-138), P < 0.05]. Psychometric hepatic encephalopathy score (PHES) [-5.5 (-4 to -9), vs. -4 (-3 to -7), P = 0.10], alcohol as an etiology (22.7 vs. 31.2%, P = 0.68), MELD [12.5 (10-17) vs. 11 (9.7-16), P = 0.36], animal naming test [18 (16-23) vs. 18 (15-22), P = 0.35], outpatient fasting ammonia [93 (63.7-121.5) vs. 81 (67.2-96.2), P = 0.43] were similar. On univariate analysis, prior OHE, sodium levels and PHES [odds ratio (OR): 0.87 (0.75-1.0), P = 0.09], and animal naming test [OR: 0.89 (0.76-1.04), P = 0.10)] showed a trend of association, while on multivariable analysis only prior OHE [adjusted OR: 3.48 (1.07-10.74), P = 0.03] and sodium levels [adjusted OR: 0.89 (0.79-0.99), P = 0.03] were associated with recent driving accidents [model AUC (prior OHE + Na≤130), 0.70 (0.62-0.77)].
In stable outpatients with cirrhosis, a remote history of OHE and hyponatremia are most strongly associated with recent driving accidents.
肝硬化患者的认知障碍由多种因素导致。认知障碍患者发生交通事故及违规的情况更多。虽然轻微肝性脑病的存在与驾驶技能差有关，但研究结果相互矛盾，且在事故方面的关联也存在差异。
在一项针对无近期显性肝性脑病（OHE）病史（<3个月）的肝硬化稳定门诊患者的前瞻性研究中，我们评估了驾驶的总体情况、近期（<1个月）自我报告的事故以及与驾驶事故相关的因素。
433例患者中，147例（33.9%）[年龄55（46 - 61）岁，97.9%为男性，29.9%与酒精相关，13.6%有既往OHE病史，终末期肝病模型（MELD）评分11（10 - 16），45.5%使用乳果糖，23.1%使用利福昔明]报告近期（≤1个月）有驾驶行为，其中22例（14.9%）有近期驾驶事故。报告有事故的患者既往OHE病史比例更高（31.8%对10.5%，P<0.05），血钠水平更低[131（129 - 134）对134（132 - 138），P<0.05]。心理测量肝性脑病评分（PHES）[-5.5（-4至-9）对-4（-3至-7），P = 0.10]、酒精作为病因（22.7%对31.2%，P = 0.68）、MELD评分[12.5（10 - 至17）对11（9.7 - 16），P = 0.36]、动物命名测试[18（16 - 23）对18（15 - 22），P = 0.35]、门诊空腹血氨水平[93（63.7 - 121.5）对81（67.2 - 96.2），P = 0.43]相似。单因素分析中，既往OHE病史、血钠水平和PHES[比值比（OR）：0.87（0.75 - 1.0），P = 0.09]以及动物命名测试[OR：0.89（0.76 - 1.04），P = 0.10]显示出关联趋势，而多因素分析中只有既往OHE病史[校正OR：3.48（1.07 - 10.74），P = 0.03]和血钠水平[校正OR：0.89（0.79 - 0.99），P = 0.03]与近期驾驶事故相关[模型曲线下面积（既往OHE病史 + 血钠≤130），0.70（0.62 - 0.77）]。
在肝硬化稳定门诊患者中，既往OHE病史和低钠血症与近期驾驶事故关联最为密切。
