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Prospective evaluation of the impact of covert hepatic encephalopathy on quality of life and sleep in cirrhotic patients
Author(s) -
Labenz C.,
Baron J. S.,
Toenges G.,
Schattenberg J. M.,
Nagel M.,
Sprinzl M. F.,
NguyenTat M.,
Zimmermann T.,
Huber Y.,
Marquardt J. U.,
Galle P. R.,
Wörns M.A.
Publication year - 2018
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.14824
Subject(s) - medicine , hepatic encephalopathy , pittsburgh sleep quality index , quality of life (healthcare) , prospective cohort study , encephalopathy , gastroenterology , cirrhosis , sleep quality , psychiatry , cognition , nursing
Summary Background Minimal hepatic encephalopathy ( HE ) and HE grade 1 ( HE 1) according to the West Haven criteria have recently been grouped as one entity named—covert HE ‐ ( CHE ). Data regarding the impact of CHE on health‐related quality of life ( HRQ oL) and sleep quality are controversial. Aim First, to determine whether CHE affects HRQ oL and sleep quality of cirrhotic patients and second, whether minimal HE ( MHE ) and HE 1 affect HRQ oL and sleep quality to a comparable extent. Methods A total of 145 consecutive cirrhotic patients were enrolled. HE 1 was diagnosed clinically according to the West Haven criteria. Critical flicker frequency and the Psychometric Hepatic Encephalopathy Score were used to detect MHE . Chronic Liver Disease Questionnaire ( CLDQ ) was used to assess HRQ oL and Pittsburgh Sleep Quality Index ( PSQI ) was applied to assess sleep quality. Results Covert HE was detected in 59 (40.7%) patients ( MHE : n = 40; HE 1: n = 19). Multivariate analysis identified CHE ( P < 0.001) and female gender ( P = 0.006) as independent predictors of reduced HRQ oL ( CLDQ total score). CHE ( P = 0.021), low haemoglobin ( P = 0.024) and female gender ( P = 0.003) were identified as independent predictors of poor sleep quality ( PSQI total score). Results of CLDQ and PSQI were comparable in patients with HE 1 and MHE ( CLDQ : 4.6 ± 0.9 vs 4.5 ± 1.2, P = 0.907; PSQI : 11.3 ± 3.8 vs 9.9 ± 5.0, P = 0.3). Conclusion Covert HE was associated with impaired HRQ oL and sleep quality. MHE and HE 1 affected both outcomes to a comparable extent supporting the use of CHE as a clinically useful term for patients with both entities of HE in clinical practice.