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Hepatic Encephalopathy Is Associated with Persistent Learning Impairments Despite Adequate Medical Treatment: A Multicenter, International Study

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Abstract

Background

Hepatic encephalopathy (HE) is considered reversible regarding mental status but may not be cognitively in single-center studies.

Aim

To evaluate persistence of learning impairment in prior HE compared to those who never experienced HE (no-HE) in a multicenter study.

Methods

A total of 174 outpatient cirrhotics from three centers (94 Virginia, 30 Ohio, and 50 Rome; 36 prior HE) underwent psychometric hepatic encephalopathy score (PHES) and inhibitory control (ICT) testing at baseline and then at least 7 days apart. ICT learning (change in 2nd half lures compared to 1st half) was compared between patient groups at both visits. Change in the PHES individual sub-tests and total score between visits was compared in both groups. US versus Italian trends were also analyzed.

Results

HE patients had worse PHES and ICT results compared to no-HE patients at baseline. Significant improvement (1st half 7.1 vs. 2nd half 6.2, p < 0.0001) was observed in no-HE, but not in HE (1st half 7.9 vs. 2nd half 7.8, p = 0.1) at baseline. At retesting (median 20 days later), no-HE patients continued with significant learning (1st half 6.0 vs. 2nd half 5.4, p < 0.0001), while HE patients again did not improve (1st half 7.8 vs. 2nd half 6.9, p = 0.37). Between visits, no-HE patients improved significantly on four PHES sub-tests and overall score, while HE patients only improved on two sub-tests with similar overall PHES score. Trends were similar between US and Italian subjects.

Conclusion

In this multicenter study, prior HE patients showed persistent significant learning impairment compared to those without prior HE, despite adequate medical therapy. This persistent change should increase efforts to reduce the first HE episode.

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Abbreviations

PHES:

Psychometric hepatic encephalopathy score

ICT:

Inhibitory control test

MMSE:

Mini-mental status examination

DST:

Digit symbol test

TMT-A:

Trail making test A

TMT-B:

Trail making test B

SDT:

Serial dotting test

LTT:

Line tracing test

HRQoL:

Health-related quality of life

SBP:

Spontaneous bacterial peritonitis

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Funding

This work was partly supported by NIDDK Grant RO1DK089713 awarded to JSB.

Author’s contribution

JSB, OR, and KDM were involved in the conceptualization of the project; SN, SA, RP, SG, AU, MB, EA, and ACF were responsible for recruitment and analysis of results; and SN, OR, AF, JBW, KDM, and JSB drafted the manuscript and were responsible for critical revisions.

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Correspondence to Jasmohan S. Bajaj.

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Nardelli, S., Allampati, S., Riggio, O. et al. Hepatic Encephalopathy Is Associated with Persistent Learning Impairments Despite Adequate Medical Treatment: A Multicenter, International Study. Dig Dis Sci 62, 794–800 (2017). https://doi.org/10.1007/s10620-016-4425-6

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  • DOI: https://doi.org/10.1007/s10620-016-4425-6

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