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Minimal hepatic encephalopathy impairs health-related quality of life and predicts overt hepatic encephalopathy in cirrhotic patients.
Lactulose is effective in the treatment of minimal hepatic encephalopathy.
However, not all patients respond to lactulose.
Dr Praveen Sharma and colleagues from India evaluated predictors of nonresponse to lactulose.
The researchers evaluated consecutive 110 cirrhotic patients without hepatic encephalopathy for minimal hepatic encephalopathy by psychometry, P300 auditory event-related potential, venous ammonia and critical flicker frequency.
Minimal hepatic encephalopathy was diagnosed by abnormal psychometry and P300 auditory event-related potential.
Minimal hepatic encephalopathy patients were treated with lactulose for 1 month.
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| The prevalence of minimal hepatic encephalopathy was 55% |
| Liver International |
Response was defined by normalization of the abnormal test parameters.
The research team diagnosed 55% of patients as having minimal hepatic encephalopathy: 44% in Child's A, 50% in Child's B and 76% in Child's C.
There was a significant difference between Child's C's vs Child's A's and B's.
Abnormal psychometric tests and abnormal P300 auditory event-related potential were seen in 67% and 67% of patients respectively.
Of 60 patients with minimal hepatic encephalopathy, after treatment, psychometry remained abnormal in 22 and P300 auditory event-related potentia in 21 patients.
The researchers found critical flicker frequency was smaller than 38 Hz in 34 and 11 patients, respectively, before and after treatment in minimal hepatic encephalopathy patients.
There was a significant difference between the baseline serum sodium level and the venous ammonia level between responders vs nonresponders.
The team performed receiver operating characteristic analysis to identify the cutoff for venous ammonia and for the serum sodium level.
Taking a cutoff of 93.5 mmol/L for ammonia patient had a sensitivity of 89% and a specificity of 79%, respectively and a cutoff of 132.5 mmol/L for serum sodium patient had a sensitivity of 77% and a specificity of 89% for nonresponse to lactulose.
On univariate analysis and multivariate analysis, serum sodium and venous ammonia were the only two parameters associated with nonresponse to lactulose.
Dr Sharma's team concluded, “The prevalence of minimal hepatic encephalopathy was 55% and minimal hepatic encephalopathy improved in 57% patients with lactulose.”
“Baseline low serum sodium and high venous ammonia were highly predictive of nonresponse to lactulose therapy.”
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