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Overt HE affected cognitive ability in patients with cirrhosis

Patients treated for cirrhosis who experienced a previous overt hepatic encephalopathy episode showed learning impairment, according to recent study data.

Researchers conducted a longitudinal study of 213 patients with cirrhosis enrolled at a hepatology center in India between January 2012 and May 2013. Analysis included 102 patients who completed the study and were divided into two groups, those with previous episodes of overt hepatic encephalopathy (OHE; n=50) and those with no previous OHE events (n=52).

Of the patients without previous OHE events, 14 were considered minimal HE (MHE) and 38 had no minimal HE (NMHE) events, based on psychometric hepatic encephalopathy score (PHES). Thirty of the OHE patients were NMHE and 20 were MHE. All patients underwent PHES evaluation at day 1, 3 and between 30 and 60 days.

Data indicated that patients with a previous OHE incident showed no improvement in PHES between the first two evaluations, implying loss in learning ability, before improving at the third assessment. MHE patients in this group did not improve in PHES (P=.214) on day 3, but also improved between 30 and 60 days (P=.002). NMHE patients failed to improve between the first and second evaluations (P=.197). Patients without prior OHE episodes demonstrated learning effect regardless of whether they had MHE or NMHE (P<.0001).

Univariate analysis revealed that lactulose and or rifaximin therapy, the presence of MHE and a previous OHE episode were associated with learning impairment. In multivariate analysis, only an OHE episode affected learning (adjusted OR=38.398; 95% CI, 9.192-160.4).

“This study has conclusively demonstrated the loss of learning ability in cirrhotic patients after a previous episode of OHE despite normal mental status,” the researchers wrote. “Patients with a previous episode of OHE might be prioritized for liver transplantation because of persistence of cognitive impairment and a higher incidence of post-transplantation neurological complications.”

Disclosure: The researchers report no relevant financial disclosures.