Original Article Prevalence of minimal hepatic encephalopathy and quality of life in patients with decompensated cirrhosis Aline Mina, 1 Segundo Moran, 1 Nayeli Ortiz-Olvera, 1 Robertino Mera 3 and Misael Uribe 2 1 Laboratory of Gastro-hepatology Research, Hospital de Pediatría and Gastroenterology Department, CMN Siglo XXI, Mexican Institute of Social Security, 2 Médica Sur Clinic and Foundation, Mexico City, Mexico; and 3 Vanderbilt University Medical Center, Nashville, Tennessee, USA Aim: Minimal hepatic encephalopathy (MHE) affects more than 30% of patients with cirrhosis, and it has been suggested that despite no recognizable clinical symptoms of neurologi- cal abnormalities, it may affect health-related quality of life (HRQL); however, this fact remains controversial. The aim of our study was to evaluate the prevalence of MHE and HRQL in patients diagnosed with decompensated cirrhosis. Methods: Patients with liver cirrhosis were selected inde- pendent of the etiology of the disease. All patients underwent a complete clinical history, and only patients with decompen- sated hepatic cirrhosis were included. Psychometric tests were applied to evaluate the presence of MHE along with the Chronic Liver Disease Questionnaire. Appetite was measured by verbal and visual analog scales. Results: One hundred and twenty-five patients were in- cluded with a median age of 56.0 years. They were classified according to the Child–Pugh index as A, (n = 56), B, (n = 51) and C (n = 18). Prevalence of MHE was 44.0% (n = 55). In patients with MHE, a significant reduction was observed in domains of activity (3.3 [2.0] vs 4.8 [2.8]), fatigue (3.2 [2.0] vs 3.9 [2.3]), systemic symptoms (3.8 [2.0] vs 4.8 [1.7]), emotional function (3.6 [1.9] vs 4.0 [1.9]) and global scoring (3.7 [1.7] vs 4.3 [1.8]) when compared with non-MHE patients (n = 70). Twenty-two percent of the patients with MHE reported little appetite compared with 11% in the non-MHE group. Conclusion: The results suggest that MHE and a reduction in appetite are associated with deterioration in HRQL in patients with decompensated cirrhosis. Key words: appetite, decompensated cirrhosis, health-related quality of life, minimal hepatic encephalopathy. INTRODUCTION M INIMAL HEPATIC ENCEPHALOPATHY (MHE) is a complication of liver cirrhosis that is character- ized by the presence of cognitive alterations undiag- nosed during routine clinical examination and identified solely through psychometric or neurological tests. 1–6 The prevalence of MHE in patients with cirrhosis varies between 30% and 84% 5,6 likely due to difference in criteria used to diagnosis MHE and due to the popu- lation selected. 7 It has been suggested that MHE can affect patients’ daily activities, work performance and health-related quality of life (HRQL), as well as increase the risk of falls and causing and/or suffering traffic accidents. MHE may also predict the development of overt hepatic encepha- lopathy (OHE). 5,8 Factors associated with impaired HRQL in patients with cirrhosis include decompensation due to compli- cations caused by the disease such as OHE, ascites and loss of appetite. 9–12 Nevertheless, there is no consistency in the effect of MHE on the HRQL of patients with cirrhosis, and appetite has not yet been explored in patients with MHE. 5,7,8,13,14 For the aforementioned reasons, the objectives of the present study were to estimate the prevalence of MHE and to evaluate HRQL in a group of patients with decompensated liver disease. METHODS Subjects P ATIENTS BETWEEN 18 and 75 years of age diag- nosed with decompensated cirrhosis of any etiology attending the Gastroenterology Research Laboratory at Correspondence: Mr Segundo Morán, Laboratory of Gastro-hepatology Research, Hospital de Pediatría, CMN, Siglo XXI, IMSS. Av Cuauhtémoc 330, Colonia Doctores, Delegación Cuauhtémoc, 06720 Mexico, DF, Mexico. Email: segundomoran@hotmail.com Received 15 May 2013; revision 11 August 2013; accepted 12 August 2013. Hepatology Research 2014; 4: E92–E99 doi: 10.1111/hepr.12227 © 2013 The Japan Society of Hepatology E92