Screening for minimal hepatic encephalopathy in patients with cirrhosis by cirrhosis-related symptoms and a history of overt hepatic encephalopathy

Yoshimura,Emi; Ichikawa,Tatsuki; Miyaaki,Hisamitsu; Taura,Naota; Miuma,Satoshi; Shibata,Hidataka; Honda,Takuya; Takeshima,Fuminao; Nakao,Kazuhiko

doi:10.3892/br.2016.702

Screening for minimal hepatic encephalopathy in patients with cirrhosis by cirrhosis-related symptoms and a history of overt hepatic encephalopathy

Authors:
- Emi Yoshimura
- Tatsuki Ichikawa
- Hisamitsu Miyaaki
- Naota Taura
- Satoshi Miuma
- Hidataka Shibata
- Takuya Honda
- Fuminao Takeshima
- Kazuhiko Nakao
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Affiliations: Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Science, Nagasaki 852‑8501, Japan, Department of Gastroenterology, Nagasaki Harbor Medical Center, City Hospital, Nagasaki 850‑8555, Japan
Published online on: June 13, 2016 https://doi.org/10.3892/br.2016.702
Pages: 193-198

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Abstract

The diagnosis of minimal hepatic encephalopathy (MHE) is more difficult in comparison to the diagnosis of overt hepatic encephalopathy (OHE), as patients with MHE do not exhibit overt neurological deficits and must be diagnosed using specialized equipment. However, identifying MHE is critical for patients with cirrhosis, and a simple screening test is required. The present study aimed to evaluate the associations between MHE, clinical characteristics and questionnaire items regarding sleep disturbances and cirrhosis‑related symptom score (CSS). A total of 91 patients who had cirrhosis without OHE were evaluated using various questionnaires [i.e., CSS, Epworth Sleepiness Scale, the Japanese version of the Pittsburgh Sleep Quality Index (PSQI) and the Japanese 36‑item short‑form health survey (SF‑36)]. MHE was diagnosed using the neuropsychological test. MHE was associated with severe liver damage, which was indicated by liver damage markers and a history of OHE. In addition, MHE was associated with the CSS, PSQI and SF‑36 results. The multivariate analyses revealed that a history of OHE was the factor that was the most strongly associated with MHE. Among patients without a history of OHE, MHE was most strongly associated with CSS, although it was also associated with severe liver damage and platelet counts. A prediction score (calculated using a history of OHE and CSS) provided an area under the receiver operating characteristic curve of 0.738 and a sensitivity of 0.671 for identifying MHE. In conclusion, a history of OHE and CSS may be useful for identifying MHE in patients with cirrhosis.

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1	Romero-Gómez M, Montagnese S and Jalan R: Hepatic encephalopathy in patients with acute decompensation of cirrhosis and acute-on-chronic liver failure. J Hepatol. 62:437–447. 2015. View Article : Google Scholar : PubMed/NCBI
2	Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K and Blei AT: Hepatic encephalopathy - definition, nomenclature, diagnosis, and quantification: Final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 35:716–721. 2002. View Article : Google Scholar : PubMed/NCBI
3	Kato A, Watanabe Y, Sawara K and Suzuki K: Diagnosis of sub-clinical hepatic encephalopathy by Neuropsychological Tests (NP-tests). Hepatol Res. 38(Suppl 1): S122–S127. 2008. View Article : Google Scholar : PubMed/NCBI
4	Qi R, Zhang LJ, Luo S, Ke J, Kong X, Xu Q, Liu C, Lu H and Lu GM: Default mode network functional connectivity: A promising biomarker for diagnosing minimal hepatic encephalopathy: CONSORT-compliant article. Medicine (Baltimore). 93:e2272014. View Article : Google Scholar : PubMed/NCBI
5	Cona G, Montagnese S, Bisiacchi PS, Gatta A, Cillo U, Angeli P, Amodio P and Schiff S: Early markers of neural dysfunction and compensation: A model from minimal hepatic encephalopathy. Clin Neurophysiol. 125:1138–1144. 2014. View Article : Google Scholar : PubMed/NCBI
6	Kircheis G, Hilger N and Häussinger D: Value of critical flicker frequency and psychometric hepatic encephalopathy score in diagnosis of low-grade hepatic encephalopathy. Gastroenterology. 146:961–969. 2014. View Article : Google Scholar : PubMed/NCBI
7	Montoliu C, Cauli O, Urios A, ElMlili N, Serra MA, Giner-Duran R, González-Lopez O, Del Olmo JA, Wassel A, Rodrigo JM, et al: 3-nitro-tyrosine as a peripheral biomarker of minimal hepatic encephalopathy in patients with liver cirrhosis. Am J Gastroenterol. 106:1629–1637. 2011. View Article : Google Scholar : PubMed/NCBI
8	Montoliu C, Piedrafita B, Serra MA, del Olmo JA, Urios A, Rodrigo JM and Felipo V: IL-6 and IL-18 in blood may discriminate cirrhotic patients with and without minimal hepatic encephalopathy. J Clin Gastroenterol. 43:272–279. 2009. View Article : Google Scholar : PubMed/NCBI
9	Riggio O, Amodio P, Farcomeni A, Merli M, Nardelli S, Pasquale C, Pentassuglio I, Gioia S, Onori E, Piazza N, et al: A Model for Predicting Development of Overt Hepatic Encephalopathy in Patients With Cirrhosis. Clin Gastroenterol Hepatol. 13:1346–1352. 2015. View Article : Google Scholar : PubMed/NCBI
10	Ampuero J, Simón M, Montoliú C, Jover R, Serra MÁ, Córdoba J and Romero-Gómez M: Minimal hepatic encephalopathy and critical flicker frequency are associated with survival of patients with cirrhosis. Gastroenterology. 149:1483–1489. 2015. View Article : Google Scholar : PubMed/NCBI
11	Bajaj JS, Saeian K, Schubert CM, Hafeezullah M, Franco J, Varma RR, Gibson DP, Hoffmann RG, Stravitz RT, Heuman DM, et al: Minimal hepatic encephalopathy is associated with motor vehicle crashes: The reality beyond the driving test. Hepatology. 50:1175–1183. 2009. View Article : Google Scholar : PubMed/NCBI
12	Bajaj JS, Pinkerton SD, Sanyal AJ and Heuman DM: Diagnosis and treatment of minimal hepatic encephalopathy to prevent motor vehicle accidents: A cost-effectiveness analysis. Hepatology. 55:1164–1171. 2012. View Article : Google Scholar : PubMed/NCBI
13	Kawaguchi T, Taniguchi E and Sata M: Motor vehicle accidents: How should cirrhotic patients be managed? World J Gastroenterol. 18:2597–2599. 2012. View Article : Google Scholar : PubMed/NCBI
14	Román E, Córdoba J, Torrens M, Torras X, Villanueva C, Vargas V, Guarner C and Soriano G: Minimal hepatic encephalopathy is associated with falls. Am J Gastroenterol. 106:476–482. 2011. View Article : Google Scholar : PubMed/NCBI
15	Bianchi G, Giovagnoli M, Sasdelli AS and Marchesini G: Hepatic encephalopathy and health-related quality of life. Clin Liver Dis. 16:159–170. 2012. View Article : Google Scholar : PubMed/NCBI
16	Kato A, Tanaka H, Kawaguchi T, Kanazawa H, Iwasa M, Sakaida I, Moriwaki H, Murawaki Y, Suzuki K and Okita K: Nutritional management contributes to improvement in minimal hepatic encephalopathy and quality of life in patients with liver cirrhosis: A preliminary, prospective, open-label study. Hepatol Res. 43:452–458. 2013. View Article : Google Scholar : PubMed/NCBI
17	Matsuzaki T, Ichikawa T, Kondo H, Taura N, Miyaaki H, Isomoto H, Takeshima F and Nakao K: Prevalence of restless legs syndrome in Japanese patients with chronic liver disease. Hepatol Res. 42:1221–1226. 2012. View Article : Google Scholar : PubMed/NCBI
18	Ichikawa T, Naota T, Miyaaki H, Miuma S, Isomoto H, Takeshima F and Nakao K: Effect of an oral branched chain amino acid-enriched snack in cirrhotic patients with sleep disturbance. Hepatol Res. 40:971–978. 2010. View Article : Google Scholar : PubMed/NCBI
19	Akahoshi M, Ichikawa T, Taura N, Miyaaki H, Yamaguchi T, Yoshimura E, Takahara I, Soyama A, Takatsuki M, Kondo H, et al: Sleep disturbances and quality of life in patients after living donor liver transplantation. Transplant Proc. 46:3515–3522. 2014. View Article : Google Scholar : PubMed/NCBI
20	Fukuhara S and Suzukamo Y: Manual of the SF-36v2 Japanese Version. Institute for Health Outcomes and Process Evaluation Research. Kyoto, Japan: 2004.
21	Johns MW: A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep. 14:540–545. 1991.PubMed/NCBI
22	Doi Y, Minowa M, Uchiyama M, Okawa M, Kim K, Shibui K and Kamei Y: Psychometric assessment of subjective sleep quality using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J) in psychiatric disordered and control subjects. Psychiatry Res. 97:165–172. 2000. View Article : Google Scholar : PubMed/NCBI
23	Buysse DJ, Reynolds CF III, Monk TH, Berman SR and Kupfer DJ: The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res. 28:193–213. 1989. View Article : Google Scholar : PubMed/NCBI
24	Hirano H, Saito M, Yano Y, Momose K, Yoshida M, Tanaka A and Azuma T: Chronic liver disease questionnaire would be a primary screening tool of neuropsychiatric test detecting minimal hepatic encephalopathy of cirrhotic patients. Hepatol Res. 45:994–1003. 2015. View Article : Google Scholar
25	Nabi E, Thacker LR, Wade JB, Sterling RK, Stravitz RT, Fuchs M, Heuman DM, Bouneva I, Sanyal AJ, Siddiqui MS, et al: Diagnosis of covert hepatic encephalopathy without specialized tests. Clin Gastroenterol Hepatol. 12:1384–1389.e2. 2014. View Article : Google Scholar : PubMed/NCBI
26	Lin WC, Chou KH, Chen CL, Chen HL, Lu CH, Li SH, Huang CC, Lin CP and Cheng YF: Longitudinal brain white matter alterations in minimal hepatic encephalopathy before and after liver transplantation. PLoS One. 9:e1058872014. View Article : Google Scholar : PubMed/NCBI
27	Umapathy S, Dhiman RK, Grover S, Duseja A and Chawla YK: Persistence of cognitive impairment after resolution of overt hepatic encephalopathy. Am J Gastroenterol. 109:1011–1019. 2014. View Article : Google Scholar : PubMed/NCBI
28	Córdoba J: New assessment of hepatic encephalopathy. J Hepatol. 54:1030–1040. 2011. View Article : Google Scholar : PubMed/NCBI