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Previous overt hepatic encephalopathy rather than minimal hepatic encephalopathy impairs health‐related quality of life in cirrhotic patients

2011; Wiley; Volume: 31; Issue: 10 Linguagem: Inglês

10.1111/j.1478-3231.2011.02598.x

1478-3231

Federica Moscucci, Silvia Nardelli, I. Pentassuglio, Chiara Pasquale, Lorenzo Ridola, Manuela Merli, Oliviero Riggio,

Organ Transplantation Techniques and Outcomes

Abstract Background It has been observed that overt hepatic encephalopathy ( HE ) is accompanied by a persistent cognitive defect, suggesting that HE may not be fully reversible. The health‐related quality‐of‐life ( HRQ oL) has been shown to be impaired by cirrhosis, and, according to some reports, influenced by minimal HE . Little is known about the effect of previous HE on HRQ oL. Aim To investigate the relative impact of previous HE and minimal HE on HRQ oL in a group of consecutively hospitalized cirrhotic patients. Patients/Methods Seventy five consecutive cirrhotic patients were evaluated using the Psychometric HE Score ( PHES ) and simplified Psychometric HE Score ( SPHES ) to detect the presence of minimal HE and using SF ‐36 to assess the HRQ oL, both corrected for age and education. Eighteen of them had previous bouts of overt HE . Results Minimal HE was significantly more frequent in patients with previous HE than in those without (p < 0.001), independently on the method used for the diagnosis ( PHES or SPHES ). A deeper impairment in several domains of SF ‐36 was observed in patients with previous bouts of overt HE , in those with ascites, as well as in those with decompensated cirrhosis. At multivariate analysis, ascites, MELD score and previous HE were independently related to the mental‐component‐summary ( MCS ) of SF ‐36, whereas ascites was the only variable independently associated with the physical‐component‐summary ( PCS ) of SF ‐36. Minimal HE (independently on the method used for its diagnosis) impaired only one domain of SF ‐36. Conclusions These data suggest that previous bouts of HE , despite their complete clinical resolution, play an independent role in producing a persistent impairment in HRQ oL of cirrhotics.