Prevalence and risk factors for minimal hepatic encephalopathy in cirrhotic patients with different etiologies

Aims: Minimal hepatic encephalopathy (MHE) significantly affects the prognosis of patients with cirrhosis. This study was performed to determine whether there is a difference in the prevalence of MHE among patients with cirrhosis of different etiologies and whether the etiology directly influences the occurrence of MHE. Methods: This multicenter, cross-sectional study enrolled 1879 patients with confirmed cirrhosis at 40 hospitals from October 25, 2021, to January 10, 2023 (Trial registration: ). The patients' demographics, etiologies of cirrhosis, and laboratory test results were collected. The psychometric hepatic encephalopathy score (PHES) was determined in all patients to screen for MHE. Multivariate logistic analyses were performed to identify the risk factors for MHE. Results: In total, 736 patients with cirrhosis were analyzed. The prevalence of MHE was 42.0% (n = 309). The primary etiology among all patients was hepatitis B virus (HBV)-related cirrhosis (71.9% [529/736]). The prevalence of MHE was significantly higher in patients with alcoholic cirrhosis (57.1% [40/70]) than in those with HBV-related cirrhosis (40.6% [215/529], p = 0.009) or hepatitis C virus (HCV)-related cirrhosis (38.2% [26/68], p = 0.026). Age (odds ratio [OR], 1.042; 95% confidence interval [CI], 1.024-1.059; p < 0.001), duration of education (OR, 0.935; 95% CI, 0.899-0.971; p = 0.001), etiology (OR, 1.740; 95% CI, 1.028-2.945; p = 0.039), and high MELD-Na scores (OR, 1.038; 95% CI, 1.009-1.067; p = 0.009) were independent risk factors for MHE. When patients with cirrhosis of different etiologies were analyzed separately, the results showed that age (OR, 1.035; 95% CI, 1.014-1.057; p = 0.001) and duration of education (OR, 0.924; 95% CI, 0.883-0.966; p = 0.001) were risk factors for MHE among patients with HBV-related cirrhosis, whereas age (OR, 1.138; 95% CI, 1.033-1.254; p = 0.009) and creatinine concentration (OR, 16.487; 95% CI, 1.113-244.160; p = 0.042) were risk factors for MHE in patients with HCV-related cirrhosis. No risk factors for MHE were found in patients with autoimmune cirrhosis. For patients with alcoholic cirrhosis, the platelet count (OR, 1.014; 95% CI, 1.000-1.027; p = 0.045) was a risk factor for MHE. The PHES subtest results were inconsistent among patients who had MHE with cirrhosis of different etiologies. Patients with HBV-related cirrhosis performed better on Number Connection Test B and the serial dotting test than those with alcoholic cirrhosis (p = 0.007 and p < 0.001), better on Number Connection Test B than those with HCV-related cirrhosis (p = 0.020), and better on the line tracing test than those with autoimmune cirrhosis (p = 0.037). Conclusion: The etiology of cirrhosis affected the prevalence of MHE and risk factors for MHE. The domains of major cognitive impairment varied among patients with cirrhosis of different etiologies. Further studies are required to verify these findings.