Minimal hepatic encephalopathy may be present despite the absence of non-invasive and elastography evidence of cirrhosis in patients with primary biliary cholangitis |
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| Affiliation: | 1. Department of Gastroenterology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland;2. Department of Radiology, Medical University of Bialystok, Bialystok, Poland;3. Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Bialystok, Poland;1. Department of Pneumonology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland;2. Department of Respiratory Medicine, Allergology and Pulmonary Oncology, Poznan University of Medical Sciences, Poznan, Poland;3. Department of Epidemiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland;4. Department of Cardiac Anaesthesia and Intensive Care, Silesian Centre for Heart Diseases in Zabrze, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland;5. Faculty of Science and Technology, University of Silesia in Katowice, 75 Pułku Piechoty 1A, 41-500, Chorzów, Poland;6. Department of Swimming and Water Rescue, Institute of Sport Science, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland;7. Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland;1. Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran;2. Department of Biology, Damghan Branch, Islamic Azad University, Damghan, Iran;1. Department of Experimental Oncology, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia;2. Department of Biomedical Sciences, University of Hull, Hull, UK;1. Department of Ophthalmology, University of Lübeck, Lübeck, Germany;2. Laboratory for Angiogenesis & Ocular Cell Transplantation, University of Lübeck, Lübeck, Germany |
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| Abstract: | PurposeMinimal hepatic encephalopathy (MHE) is an important complication of chronic liver disease (CLD); however, MHE burden in patients with primary biliary cholangitis (PBC) has not been determined yet. Therefore, our study aimed to assess the prevalence of MHE in a typical cohort of middle-aged, patients with PBC suspicion of liver fibrosis and to investigate the relationship between MHE, basic laboratory tests and the stage of liver fibrosis.Patients and methodsFifty-one patients (38 with PBC and 13 controls), were prospectively enrolled. Portosystemic Encephalopathy-Syndrome test was used to diagnose MHE. Elastography point qualification (ElastPQ) and non-invasive markers (APRI and FIB-4) were used to assess liver fibrosis. The severity of CLD was assessed using the Model of End-Stage Liver Disease (MELD) and Child-Pugh score.ResultsMHE was diagnosed in 9 patients (24.3%) with PBC and none in the control group. As many as 44.4% of the patients with MHE had neither advanced fibrosis nor cirrhosis, as demonstrated using non-invasive markers of liver fibrosis or ElastPQ. The MELD score was the only predictor of MHE with cut-off value 8.5 [AUC = 0.753, CI95% = 0.569 to 0.938)] with sensitivity of 56%, specificity of 85% and accuracy of the test of 78%. Non-invasive markers of liver fibrosis and ElastPQ did not predict MHE.ConclusionsMHE may occur in PBC despite no evidence of advanced liver fibrosis or cirrhosis. The slightly elevated MELD score may indicate a substantially increased risk of MHE in patients with PBC. |
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| Keywords: | Liver cirrhosis Liver fibrosis Minimal hepatic encephalopathy Primary biliary cholangitis Psychometric test |
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