Covert or Minimal Hepatic Encephalopathy Is a Common Complication of Cirrhosis

Covert or minimal hepatic encephalopathy (C/MHE) has been associated with falls, motor vehicle accidents, and worsened liver-related outcomes from cirrhosis, but diagnosis requires specialized testing and frequently is missed. In this systematic review of 101 studies, researchers pooled data from 16,000 patients with cirrhosis to estimate the prevalence of C/MHE and identify patient characteristics associated with excess risk. In all studies, C/MHE was diagnosed using neuropsychological tests: the psychometric hepatic encephalopathy score (PHES) — a composite of five separate psychometric tests — was used most commonly and typically is regarded as the gold standard.

Key findings were as follows:

• The prevalence of C/MHE increased with worsenin…