Brief Article
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World J Gastroenterol. Aug 14, 2013; 19(30): 4984-4991
Published online Aug 14, 2013. doi: 10.3748/wjg.v19.i30.4984
Prevalence of minimal hepatic encephalopathy and quality of life evaluations in hospitalized cirrhotic patients in China
Ji-Yao Wang, Ning-Ping Zhang, Bao-Rong Chi, Yu-Qing Mi, Li-Na Meng, Ying-Di Liu, Jiang-Bin Wang, Hai-Xing Jiang, Jin-Hui Yang, Yun Xu, Xiao Li, Jian-Ming Xu, Guo Zhang, Xin-Min Zhou, Yu-Zheng Zhuge, De-An Tian, Jin Ye, Yu-Lan Liu
Ji-Yao Wang, Ning-Ping Zhang, Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Center of Clinical Epidemiology and Evidence-based Medicine, Fudan University, Shanghai 200032, China
Bao-Rong Chi, Department of Digestive Diseases, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Yu-Qing Mi, Department of Hepatology, Tianjin Infectious Disease Hospital, Tianjin 300192, China
Li-Na Meng, Department of Digestive Diseases, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou 310006, Zhejiang Province, China
Ying-Di Liu, Department of Digestive Diseases, Chinese PLA General Hospital (301 Hospital), Beijing 100853, China
Jiang-Bin Wang, Department of Digestive Diseases, China-Japan Union Hospital, Jilin University, Changchun 130031, Jilin Province, China
Hai-Xing Jiang, Department of Digestive Diseases, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Jin-Hui Yang, Department of Hepatology, the Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan Province, China
Yun Xu, Department of Digestive Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Xiao Li, Department of Digestive Diseases, West-China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Jian-Ming Xu, Department of Digestive Diseases, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
Guo Zhang, Department of Digestive Diseases, the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Xin-Min Zhou, Department of Digestive Diseases, Xijing Hospital, the Fourth Military Medical University, Xi’an 230022, Shaanxi Province, China
Yu-Zheng Zhuge, Department of Digestive Diseases, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
De-An Tian, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Jin Ye, Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Yu-Lan Liu, Department of Digestive Diseases, Peking University People’s Hospital, Beijing 100044, China
Author contributions: Wang JY designed and organized the study, interpreted data and revised the paper; Zhang NP collected and interpreted data and drafted the manuscript; Wang JY, Chi BR, Mi YQ, Meng LN, Liu YD, Wang JB, Jiang HX, Yang JH, Xu Y, Li X, Xu JM, Zhang G, Zhou XM, Zhuge YZ, Tian DA and Ye J enrolled patients and provided evaluable data; Liu YL coordinated the study; all authors have approved the final version of the manuscript.
Correspondence to: Ji-Yao Wang, MSc, AGAF, MD, Professor, Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Center of Clinical Epidemiology and Evidence-based Medicine, Fudan University, 180 Fenglin Road, Shanghai 200032, China. wang.jiyao@zs-hospital.sh.cn
Telephone: +86-21-64041990-2117 Fax: +86-21-2164432583
Received: June 7, 2013
Revised: July 23, 2013
Accepted: July 30, 2013
Published online: August 14, 2013
Processing time: 66 Days and 20.5 Hours
Abstract

AIM: To investigate the prevalence of minimal hepatic encephalopathy (MHE) and to assess corresponding health-related quality of life (HRQoL) in hospitalized cirrhotic patients in China.

METHODS: This multi-center cross-sectional study included 16 teaching hospitals, which were members of “Hepatobiliary Cooperation Group, Society of Gastroenterology, Chinese Medical Association”, from different areas of China carried out between June and October in 2011. All the eligible hospitalized cirrhotic patients (n = 538) were required to complete triplicate number connection tests combined with one digit symbol test for diagnosing MHE. Patients’ clinical examination data were complemented by a modified questionnaire assessing HRQoL. Written informed consent was obtained from each patient.

RESULTS: Male was predominant (68.6%) in 519 patients who met the criteria of the study, with a mean age of 49.17 ± 11.02 years. The most common cause of liver cirrhosis was chronic hepatitis B (55.9%). The prevalence of MHE was 39.9% and varied by Child-Pugh-Classification score (CPC-A: 24.8%, CPC-B: 39.4% and CPC-C: 56.1%, P < 0.01). MHE (P < 0.01) and higher CPC scores (P < 0.01) were associated with a high HRQoL scores (reflecting poorer quality of life). The prevalence of MHE was proportionate to CPC (P = 0.01) and high quality of life scores (P = 0.01).

CONCLUSION: Hospitalized cirrhotic patients have a high prevalence of MHE that is proportionate to the degree of liver function and HRQoL impairment.

Keywords: Minimal hepatic encephalopathy; Health-related quality of life; China; Child-Pugh Classification; Liver cirrhosis

Core tip: This study showed that 39.9% of hospitalized patients with liver cirrhosis had minimal hepatic encephalopathy (MHE), and patients with Child-Pugh Classification-C had a high prevalence of MHE (56.1%) and increased health-related quality of life scores that reflected poorer life status. Increasing awareness of its adverse impact on life should be emphasized. Recommendations to screen for MHE may be applicable for evaluating the risks of driving and work accidents in patients with cirrhosis.