Prevalence and risk factors of covert hepatic encephalopathy in cirrhotic patients: A multicenter study in China

Abstract

ObjectiveWe aimed to investigate the prevalence of covert hepatic encephalopathy (CHE) in cirrhotic patients in China and its risk factors.MethodsA multicenter prospective observational study was conducted from January 2021 to March 2022 at 16 medical centers across China to investigate the risk factors of CHE and establish a prediction model for CHE episodes.ResultsA total of 528 patients were enrolled in the study. Based on both the psychometric hepatic encephalopathy score and Stroop test results, the prevalence of CHE was 50.4% (266/528), and the consistency between these two tests was 68.9%. Multivariate analysis showed that age (odds ratio [OR] 1.043, 95% confidence interval [CI] 1.022–1.063, P < 0.001), duration of education (OR 0.891, 95% CI 0.832–0.954, P = 0.001), comorbidities of cardiovascular diseases, hypertension, cerebral apoplexy or diabetes mellitus (OR 2.072, 95% CI 1.370–3.133, P < 0.001), Child–Pugh score (OR 1.142, 95% CI 1.029–1.465, P = 0.025), and blood urea nitrogen concentration (OR 1.126, 95% CI 1.038–1.221, P = 0.004) were associated with CHE episodes. According to the Chronic Liver Disease Questionnaire, CHE patients had lower scores for abdominal symptoms and systemic symptoms (P < 0.001), indicating a poor health‐related quality of life. Based on a stepwise Cox regression hazard model, we established a nomogram for determining the probabilities of CHE episodes, and the area under the receiver operating characteristic curve was 0.733 (95% CI 0.679–0.788) and 0.713 (95% CI 0.628–0.797) in the training and validation cohorts.ConclusionsCHE is a common complication of cirrhosis in China. Large‐scale studies with long‐term follow‐up are needed to determine the natural history of Chinese CHE patients.