DETECTION OF MINIMAL HEPATIC ENCEPHALOPATHY USING THE PSYCHOMETRIC HEPATIC ENCEPHALOPATHY SCORE IN KOREAN PATIENTS WITH LIVER CIRRHOSIS

초록

Backgrounds/Purpose: Minimal hepatic encephalopathy(MHE) affects 30-84% of patients with liver cirrhosis. Detection of MHE is very important because it is associated with the development of overt HE, quality of life, and mortality. Various guidelines recommend the psychometric hepatic encephalopathy score (PHES) as the gold standard for the detection of MHE. However, because PHES could be influenced by several confounding factors, including age, sex, educational years, and socio-cultural background, validation in each population is needed. This study was performed to determine the normal range of PHES in Korean population. In addition, the prevalence of MHE was evaluated in Korean patients with liver cirrhosis. Methods: Two-hundred healthy people were enrolled to evaluate the normal range of PHES in Korea. Distributions of age, sex, and educational years in the healthy population were determined according to those in overall Korean population. PSE-Syndrom-Test,comprised of digit symbol test (DST), number connection test(NCT)-A, NCT-B, serial dotting test (SDT), and line drawing test (LTT), was performed in the healthy population. In addition, 112 cirrhotic patients without the evidence of overt HE were enrolled to evaluate the prevalence of MHE. Liver function test and serum ammonia level were checked on the same day of PSE-Syndrom-Test. Results: In healthy population, age did not differ between men and women, while educational years were significantly longer in men than in women (14±4 years vs 12±3 years, P=0.006). The results of DST, NCT-A, NCT-B, and LTT were significantly associated with age and educational years, while that of DST was only associated with sex. With the results of PSE-Syndrom-Test in the healthy population, mean values and standard deviations according to the age were calculated. The normal range of PHES, which was set at the 95th percentile in the healthy population, was ≥-5. The results of DST, NCT-A, NCT-B, SDT, LTT, and PHES differed significantly between the healthy population and patients with liver cirrhosis (P<0.001). MHE coexisted in 16.5% of patients with liver cirrhosis. The prevalence of MHE was significantly higher in patients with Child class B or C (33.3%) than in those with Child class A(11.3%; P<0.005). In addition, PHES was well correlated with the serum ammonia levels. Both Child score and PHES were significantly associated with the abnormal serum ammonia levels in patients with liver cirrhosis. Conclusions: This study represented the normal range of PHES in Korean population. PHES was simple and useful for detecting MHE. MHE coexisted in the significant proportion of patients with liver cirrhosis.