Minimal hepatic encephalopathy identifies patients at risk of faster cirrhosis progression.Ampuero J, Montoliú C, Simón-Talero M, Aguilera V, Millán R, Márquez C, Jover R, Rico MC, Sendra C, Serra MÁ, Romero-Gómez M. J Gastroenterol Hepatol. 2017 Aug 2. [Epub ahead of print]

BACKGROUND &AIM:Minimal hepatic encephalopathy (MHE) predicts poor prognosis and could reflect an advanced liver disease. We aimed to assess whether MHE could be a surrogate marker of a further liver disease.

METHODS:Prospective multicenter study including 320 cirrhotic patients, followed for up to 5 years, which were classified at baseline in: compensated cirrhosis without (stage 1) and with varices (stage 2), one decompensating event (stage 3), any second decompensating event (stage 4). Cirrhosis progression was defined by a transition towards a different stage (competing events: liver transplant due to hepatocellular carcinoma and non-liver-related death). MHE was detected by critical flicker frequency and psychometric tests.RESULTS:MHE was diagnosed in 18.2% (57/314) of patients. Cirrhosis progression occurred in 38.1% (122/320) of patients, while liver transplant was required in 10.9% (35/320) and 19.1% (61/320) died. In competing risk regression, MHE was associated with disease progression: model 1 [sHR 2.34 (95%CI 1.58-3.46); p=0.0001]; model 2 [sHR 2.18 (95%CI 1.43-3.33); p=0.0001]; model 3 [sHR 2.48 (95%CI 1.63-3.76); p=0.0001]. The annual incidence rate of progression was higher in MHE patients: stage 1 (19.4 vs. 5.6 cases per 100 person-years); stage 2 (26.8 vs. 15.6); stage 3 (45.7 vs. 16.5); stage 4 (40.7 vs. 12.8). MHE showed a higher cumulative incidence of disease progression from the first year in decompensated and the third year in compensated cirrhosis.CONCLUSION:MHE was associated with cirrhosis progression and showed a higher cumulative and annual incidence rate of disease progression. MHE could be a surrogate marker of disease progression, irrespective of cirrhosis status, identifying patients at risk of suffering a more aggressive cirrhosis form.

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