Prevalence and Risk Factors of Covert Hepatic Encephalopathy in Cirrhotic Patients: A Multicenter Study in China.

BACKGROUND & AIMS: We aimed to determine the prevalence of covert hepatic encephalopathy (CHE) in cirrhotic patients from China and to investigate its risk factors.

METHODS: A multicenter prospective observational study was conducted from January 2021 to March 2022 in 16 centers to investigate the impact factors of CHE and establish a prognostic model for CHE episodes.

RESULTS: Totally 528 patients were enrolled in the analysis. Based on the anomalies of both PHES and Stroop test results, the prevalence of CHE was 50.4% (266/528), and the consistency between these two tests was 68.9%. Advanced age (OR = 1.043; 95% CI: 1.022-1.063, P < 0.001), low education level (OR = 0.891; 95% CI: 0.832-0.954, P = 0.001), poor Child-Pugh score (OR = 1.142; 95% CI: 1.029-1.464, P = 0.025), and high BUN concentration (OR = 1.126; 95% CI: 1.038-1.2221, P = 0.004) were associated with CHE episodes. According to the chronic Liver Disease Questionnaire (CLDQ), CHE patients had lower scores for abdominal symptoms and systemic symptoms (P < 0.001), which reflected the poor health-related quality of life (HRQoL). According to the stepwise Cox regression hazard model analysis, we established a nomogram for determining the probabilities of CHE episodes, and the AUC was 0.733 (95% CI: 0.679-0.788) in the training cohort and 0.713 (95% CI: 0.628-0.797) in the validation cohort.

CONCLUSIONS: CHE was a common complication of cirrhosis in China. It is necessary to carry out more large-scale studies with longer follow-up periods to determine the natural history of Chinese CHE patients. This article is protected by copyright. All rights reserved.