Prevalence of Covert Hepatic Encephalopathy in A Tertiary Care Centre

Abstract

Introduction: Among patients with Hepatic Encephalopathy, prevalence of Minimal HE varies
between 30-50%. Identifying patients with MHE has been shown to improve with medications and
delay development of Overt HE, however only limited clinicians screen for MHE in patients due to
time consuming neuropsychological and neurophysiological tests. The Number Connection Test is
an easy way to evaluate patients to diagnose MHE. The aim of this study is to find out the prevalence
of covert hepatic encephalopathy.

Methods: The descriptive cross-sectional study was done to find out the prevalence of covert hepatic
encephalopathy among patients with chronic liver disease. To diagnose Covert HE which included
MHE as well, NCT was used in Devanagari script.

Results: The prevalence of covert hepatic encephalopathy is found to be 56 (58.3%) at 90% confidence
interval (58.23-58.37%). A total of 96 patients (71.9% male) were diagnosed as HE, with mean age of
49.6+11.8 years. The cause of CLD in 85 (88.5%) of these patients was alcohol, of which 76 (79.2%)
consumed locally brewed alcohol. Of these 96 patients with HE, only 40 (41.7%) had overt HE.
Among all these, maximum patients had MHE (37.5%).

Conclusions: Our study showed that although the prevalence of minimal HE is quite high among
cirrhotics, they are usually missed in clinical practice due to absence of symptoms. Active screening
with easy-to-administer tests, like Number Connection tests, can help identify patients with minimal
HE and hence treat them early.