# Utility of Psychometric Hepatic Encephalopathy Score in Diagnosing Minimal Hepatic Encephalopathy Among Liver Cirrhosis Patients in Nigeria

## TL;DR

This study evaluates the Psychometric Hepatic Encephalopathy Score (PHES) for diagnosing minimal hepatic encephalopathy in Nigerian liver cirrhosis patients.

## Contribution

Establishes a local PHES reference value in Nigeria and identifies subtest combinations for efficient MHE diagnosis.

## Key findings

- Minimal hepatic encephalopathy (MHE) prevalence was 51.8% among liver cirrhosis patients.
- Child-Pugh score and prothrombin time were independent predictors of MHE.
- Combining NCT-A and SDT subtests achieved 86.4% sensitivity with 52% shorter testing time.

## Abstract

Introduction: Hepatic encephalopathy (HE) is a critical complication of liver cirrhosis, with minimal hepatic encephalopathy (MHE) representing a subtle neurocognitive disorder within its spectrum, characterized by cognitive and motor impairments undetectable by routine clinical examinations. The Psychometric Hepatic Encephalopathy Score (PHES), comprising five psychometric tests, is the gold standard for MHE diagnosis, enabling early intervention to prevent accidents, falls, progression to overt HE, and reduced quality of life. The study aimed to establish a local PHES reference value in Nigeria and evaluate its utility in diagnosing MHE among liver cirrhosis patients.

Methods: It is a cross-sectional study; 200 apparently healthy controls and 85 liver cirrhosis patients without overt HE underwent PHES testing, including Number Connection test-A (NCT-A), Number Connection test-B (NCT-B), Digit Symbol Test (DST), Serial Dotting Test (SDT), and Line Tracing Test (LTT).

Results: The mean age of the liver cirrhosis patients was 40.5 ± 11.8 years, with a male-to-female ratio of 2.4:1, comparable to the controls. MHE was diagnosed at PHES < -5, revealing a prevalence of 51.8%. Risk factors associated with MHE included serum albumin, prothrombin time, and Child-Pugh score (p < 0.05), with Child-Pugh score (OR 9.3) and prothrombin time (OR 19.5) as independent predictors. Subtest combinations (NCT-A + NCT-B, NCT-A + SDT) showed sensitivities of 84.1% and 86.4%, respectively, and 61% specificity, reducing test time by 52%.

Conclusion: The high MHE prevalence underscores the need for PHES validation across Nigeria to develop national diagnostic guidelines.