Sleep and Rhythms Projects

Clinical, neuropsychological and neurophysiological indices and predictors of hepatic encephalopathy (HE)

Formentin C, Zarantonello L, Mangini C, Frigo A C, Montagnese S, Merkel C

Liver International

Background and Aims

The occurrence of overt hepatic encephalopathy (HE) marks a significant progression in the natural history of liver disease. The aims of the present study were to: 1) describe a large cohort of patients with cirrhosis in terms of neuropsychological or neurophysiological HE indices, and 2) test if the severity of liver disease and/or any such indices [Psychometric Hepatic Encephalopathy Score (PHES), Scan test, electroencephalography (EEG)] predicted mortality/HE risk in a subgroup of such cohort.


Four hundred and sixty‐one patients with cirrhosis (59 ± 10 years; 345 males) were included; information on previous overt HE episodes was available in 407. Follow‐up information on mortality/HE‐related hospitalization in 134/127 respectively. Information on previous overt HE episodes and both mortality and HE‐related hospitalization over the follow‐up in 124.


Patients with a history of overt HE (60%) had poorer liver function, worse neuropsychiatric indices, higher ammonia levels and higher prevalence of portal‐systemic shunt. The risk of HE‐related hospitalization over the follow‐up was higher in patients with higher MELD score and worse Scan performance. Mortality was higher in those with higher MELD. Among patients without a history of overt HE, those with worse PHES had higher HE risk. Among patients with a history, those with higher MELD, better PHES and worse Scan performance had higher HE risk.


In patients without previous overt HE episodes, neuropsychological and neurophysiological tests predict HE, while in those with previous overt HE episodes, HE development largely depends on the severity of liver dysfunction.

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