Prevalence of minimal hepatic encephalopathy in patients with liver cirrhosis: a multicenter study

Objectives: 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. Methods: In this study, data of patients recruited at 10 centers across Europe and the US were analyzed. Only patients without clinical signs of HE 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. Results: In total, 1868 patients with cirrhosis with a median MELD of 11 were analyzed (Child-Pugh stages: A 46%, B 42%, and C 12%). In the total cohort, MHE was detected by PHES in 650 (35%) patients. After excluding patients with a history of overt HE, the prevalence of MHE was 29%. In subgroup analyses, the prevalence of MHE in patients with CP A was low (25%), while 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's rho=-0.16, p<0.001). Conclusions: 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.