Psychometric hepatic encephalopathy score for diagnosis of minimal hepatic encephalopathy in cirrhosis of liver

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.