Frequency and Risk Factors of Minimal Hepatic Encephalopathy Among Patients with Compensated Cirrhosis

Eid, Abdallah Mohamed; Sharafeddin, Mahmoud Ahmed; Zurkany, Esam Nasr; Nabil, Marawan Mohamed

doi:10.21608/zumj.2020.22641.1698

Frequency and Risk Factors of Minimal Hepatic Encephalopathy Among Patients with Compensated Cirrhosis

Document Type : Original Article

Authors

¹ Internal Medicine Department, Elmatarya Teaching Hospital, Cairo, Egypt

² Internal Medicine Department, Faculty of Medicine – Zagazig University, Egypt

³ Department of Internal Medicine, Faculty of Medicine , Zagazig University, Egypt.

10.21608/zumj.2020.22641.1698

Abstract

Background: Minimal hepatic encephalopathy (MHE) is characterized by a mild neurocognitive impairment encompassing neuropsychological and neurophysiological alterations not detectable by clinical examination. This study aims at assessing the frequency and risk factors for developing minimal hepatic encephalopathy in patients with compensated cirrhosis. Methods: This cross sectional study was conducted on 60 patients with compensated cirrhosis in Elzagazig University Hospital and Elmatarya Teaching Hospital from December 2017 to June 2018, diagnosis of minimal hepatic encephalopathy was established using by mini mental status examination test and psychometric studies, they underwent full history, laboratory investigations and abdominal Doppler ultrasonography by professional radiologist assessing the presence of any Porto systemic shunts and measuring serum ammonia level. Results: About 37% had MHE. Female represented 65% with mean age 49.82 years. There is statistically significant relation between MHE and smoking, comorbid diabetes, hypertension, high ammonia level and portosystemic shunt. Smoking, being single, illiterate, portosystemic shunt, comorbid diabetes and hypertension increased risk of MHE by 4.57, 3.05, 2.31, 25.94, 3.29 and 3.55 folds. Male gender and normal ammonia level were protective factors. There is significant relation between MHE and all of age, platelet count, serum albumin, ammonia and INR. Older patients, low platelet count and serum albumin, high ammonia level and INR were detected among patients with MHE. Increasing ammonia level was significant independent risk factor for MHE (AOR= 4.06)
Conclusions: MHE is a prevalent condition among patients with compensated cirrhosis with high ammonia level and portosystemic shunts as a strong risk factors for its development.

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