Psychometric Hepatic Encephalopathy Score in the Diagnosis of Minimal Hepatic Encephalopathy in Cirrhosis of Liver: A Cross-sectional Study
Introduction: Minimal Hepatic Encephalopathy (MHE) is a subclinical condition in patients with liver cirrhosis, often preceding Overt Hepatic Encephalopathy (OHE). MHE impairs driving ability and Quality of Life (QoL) but requires specialised neuropsychological tests such as the Psychometric Hepatic...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2025-08-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2025&month=August&volume=19&issue=8&page=OC18-OC21&id=21338 |
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| Summary: | Introduction: Minimal Hepatic Encephalopathy (MHE) is a subclinical condition in patients with liver cirrhosis, often preceding Overt Hepatic Encephalopathy (OHE). MHE impairs driving ability and Quality of Life (QoL) but requires specialised neuropsychological tests such as the Psychometric Hepatic Encephalopathy Score (PHES) for diagnosis, as routine exams are insufficient.
Aim: To establish normal values for the PHES and assess its diagnostic efficacy for MHE in patients with liver cirrhosis.
Materials and Methods: A cross-sectional study was conducted at BLDE (DU) Medical College, Vijayapura, Karnataka, India, from May 2023 to December 2024, with a sample of 166 participants (cases and controls). Patients with OHE were excluded. The PHES was administered and biochemical tests including Alanine Transaminase (ALT), Aspartate Transaminase (AST), International Normalised Ratio (INR) and albumin, among others, were performed. Imaging {Ultrasound (USG) abdomen/pelvis} was also conducted. MHE was diagnosed if the PHES score was < −4 based on healthy nomograms. Statistical analysis was performed using the t-test, Mann-Whitney U test and Chi-square test, with a p-value <0.05 considered statistically significant.
Results: Of the 166 participants, 83 had cirrhosis and 83 unmatched participants without cirrhosis were included for comparison. Cases were predominantly male (92.77% vs. 67.47%, p-value <0.001). Higher proportion of controls had primary education while secondary and higher secondary education levels were slightly more prevalent among cases (p-value=0.330). Cases showed significant impairment in all PHES subtests (p-value <0.001) and a lower mean PHES score (−4.40 vs. 2.28, p-value <0.001). A total of 37.35% of cases had MHE, while none in the control group had MHE (p-value <0.001). No correlation between ammonia levels and MHE status was observed.
Conclusion: PHES is a reliable, non invasive tool for the early detection of MHE in cirrhosis patients, aiding timely intervention. While it should complement clinical evaluation, its cost-effectiveness and accessibility enhance patient management and outcomes. |
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| ISSN: | 2249-782X 0973-709X |