Abstract:
BACKGROUND:
• Minimal hepatic encephalopathy (MHE) is a subclinical condition in liver cirrhosis
patients, often preceding overt hepatic encephalopathy (OHE).
• MHE impairs driving ability and quality of life but requires specialized
neuropsychological tests (e.g., PHES) for diagnosis, as routine exams are insufficient.
Aim
• Establish normative PHES values and assess its diagnostic efficacy for MHE in cirrhosis
patients.
Methods
• Study Design: Cross-sectional study (May 2023–December 2025) at BLDE(DU)
Medical College, Vijayapura.
• Participants: 166 cirrhosis patients (cases) and controls. Overt HE patients were
excluded.
• Assessments:
o PHES battery (NCT-A, NCT-B, SDT, LTT, DST) administered in a controlled
setting.
o Biochemical tests (ALT, AST, INR, albumin, etc.) and imaging (USG
abdomen/pelvis).
o MHE diagnosis: PHES score <−4 based on healthy nomograms.
Results
• Demographics: Cases were older (p=0.003) and predominantly male (92.77% vs.
67.47%, p<0.001). No educational differences (p=0.263).
• Cognitive Performance: Cases showed significant impairment in all PHES subtests
(p<0.001) and lower mean PHES (−4.40 vs. 2.28, p<0.001).
• MHE Prevalence: 37.35% of cases had MHE; none in controls (p<0.001).
• Biochemical Markers: No correlation between ammonia levels and MHE status.
Conclusion
PHES is a reliable, non-invasive tool for early MHE detection in cirrhosis, aiding timely
intervention. While it should complement clinical evaluation, its cost-effectiveness and
accessibility enhance patient management and outcomes.
