Minimal hepatic encephalopathy in patients with cirrhosis by measuring liver stiffness and hepatic venous pressure gradient

ABSTRACT

Transient elastography [TE] of liver and hepatic venous pressure gradient [HVPG] allows accurate prediction of cirrhosis and its complications in patients with chronic liver disease. There is no study on prediction of minimal hepatic encephalopathy [MHE] using TE and HVPG in patients with cirrhosis. Consecutive cirrhotic patients who never had an episode of hepatic encephalopathy [HE] were enrolled. All patients were assessed by psychometry [number connection test [NCT-A and B], digit symbol test [DST], serial dot test [SDT], line tracing test [LTT]], critical flicker frequency test [CFF], TE by FibroScan and HVPG. MHE was diagnosed if there were two or more abnormal psychometry tests [ +/- 2 SD controls]. 150 patients with cirrhosis who underwent HVPG were screened; 91 patients [61%, age 44.0 +/- 11.4 years, MF7516, Child's ABC 185419] met the inclusion criteria. Fifty three [58%] patients had MHE [Child A [7/18, 39%], Child B [32/54, 59%] and Child C [14/19, 74%]]. There was no significant difference between alanine aminotranferease [ALT], aspartate aminotransferase [AST] and total bilirubin level in patients with MHE versus non MHE. Patients with MHE had significantly lower CFF than non MHE patients [38.4 +/- 3.0 vs. 40.2 +/- 2.2 Hz, P = 0.002]. TE and HVPG in patients with MHE did not significantly differ from patients with no MHE [30.9 +/- 17.2 vs. 29.8 +/- 18.2 KPas, P = 0.78; and 13.6 +/- 2.7 vs. 13.6 +/- 3.2 mmHg, P = 0.90, respectively].There was significant correlation of TE with Child's score [0.25, P = 0.01], MELD [0.40, P = 0.001] and HVPG [0.72, P = 0.001] while no correlation with psychometric tests, CFF and MHE. TE by FibroScan and HVPG cannot predict minimal hepatic encephalopathy in patients with cirrhosis.