Minimal Hepatic Encephalopathy Does Not Impair Health-related Quality of Life in Patients With Cirrhosis

A Prospective Study

Ewa Wunsch; Barbara Szymanik; Michał Post; Wojciech Marlicz; Marta Mydłowska; Piotr Milkiewicz


Liver International. 2011;31(7):980-984. 

In This Article

Abstract and Introduction


Background: Minimal hepatic encephalopathy (HE) is a serious complication of cirrhosis; however, the impact of minimal HE on health-related quality of life (HRQoL) remains controversial. The Psychometric Hepatic Encephalopathy Score (PHES) remains a 'gold standard' for the assessment of minimal HE, but its results clearly differ between studied populations.
Aim: We studied the effect of minimal HE on patient HRQoL.
Methods: Eighty-seven consecutive cirrhotic patients were included. All patients underwent clinical and psychometric evaluation at the same day. Ten subjects with overt HE confirmed with West Haven criteria were excluded from the study, thus 77 patients were finally analysed. Patients with minimal HE were identified on the grounds of altered PHES. HRQoL was assessed by the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and the Chronic Liver Disease Questionnaire (CLDQ). Normative reference data for PHES were established from a cohort of 305 healthy Polish subjects.
Results: Twenty-nine (37.7%) patients were diagnosed with minimal HE. When patients with and without minimal HE were compared, HRQoL was not significantly different in none of the SF-36 and CLDQ domains.
Conclusion: Minimal HE does not affect HRQoL.


Minimal hepatic encephalopathy (HE) is a subtle cognitive impairment in patients with cirrhosis or portosystemic shunts in the absence of abnormalities in standard neurological examination.[1] While minimal HE was previously considered an eligible condition, it has been shown to act as a predicting factor of overt HE.[2,3] Some studies have suggested a negative impact of minimal HE on daily functioning,[4–6] but the real influence of minimal HE on health-related quality of life (HRQoL) remains controversial because of the fact that different diagnostic tools for the assessment of minimal HE and HRQoL were used in previous analyses.

The Psychometric Hepatic Encephalopathy Score (PHES), a paper–pencil test battery, is recommended as a sensitive, valid and reliable neuropsychological tool for the quantification of minimal HE.[7] Normative databases have been collected in only a few countries; nonetheless, these databases reveal variations among studied populations.[7–10] Therefore, local normograms of healthy controls are required to meaningfully implement the PHES.

We have performed an assessment of patient HRQoL in which the minimal HE diagnosis was based on altered PHES values. Furthermore, in order to obtain Polish normograms, we have standardized PHES in healthy subjects from Polish general population.