Clinical Gastroenterology Journal

Introduction: Minimal Hepatic Encephalopathy (MHE) is the earliest manifestation of Hepatic Encephalopathy (HE). It affects a significant number of cirrhotics and contributes significantly to morbidity and mortality. It is underdiagnosed because of its subtle presentation. This study determined the aetiology, clinical features, and diagnostic performance of psychometric hepatic encephalopathy test scores for minimal hepatic encephalopathy among cirrhotic patients in a teaching hospital in Ghana.

Methods: This was a cross-sectional study at the Korle Bu Teaching Hospital in Accra, Ghana. Patients with liver cirrhosis were screened for MHE using the Psychometric Hepatic Encephalopathy Test Scores (PHES); The Number Connection Test A & B (NCT-A&B), Line Tracing Test (LTT), Digit Symbol Test (DST) and Serial Dotting Test (SDT). Cut-off points identified in normal populations were used to determine the presence of MHE. Summary statistics, independent sample t-test, chi-square and ROC curves were used in data analysis using STATA 17.

Results: Of the 136 patients with liver cirrhosis recruited 51% had MHE. The mean age (SD) of patients with MHE was 44.8 ± 13.2 years with male predominance (1.6:1). 48.5% of patients had Chronic Hepatitis B. Edema, weight loss, abdominal distension, serum ALT, GGT, albumin levels and higher Child -Pugh scores were associated with MHE. Each of the 5 PHES showed significant difference between patients with MHE and those without. NCT-B and DST had the highest predictive values of MHE with AUC of 97% and 92% respectively, while SDT had the least predictive value with an AUC of 65. The AUC for NCT-A and LCT were 89 and 81 respectively.

Conclusion: Minimal Hepatic Encephalopathy (MHE) is a prevalent condition with frequent complications of liver cirrhosis and is strongly associated with disease severity. Psychometric tests, particularly NCT-B and DST, proved effective for diagnosing MHE. Routine screening for MHE in cirrhotic patients using these tools is recommended to enable early intervention and improve clinical outcomes.