Download PDF
Z Gastroenterol 2018; 56(05): 461-468
DOI: 10.1055/s-0043-123766
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Covert hepatic encephalopathy leads to distinct alterations in the emotional state, independently of MELD-Score

Die covert hepatische Enzephalopathie führt zu negativen Alterationen der emotionalen Befindlichkeit bei Patienten mit Leberzirrhose, unabhängig vom MELD-Score
Robin Greinert   *
,
Cristina Ripoll   *
,
Alexander Zipprich
Further Information

Publication History

22 June 2017

22 November 2017

Publication Date:
16 January 2018 (online)

Also available at
    Permissions and Reprints

Abstract

Background and aims Covert hepatic encephalopathy impairs many aspects of quality of life, although its impact on the emotional state has not been evaluated. This study aims to evaluate the impact of covert hepatic encephalopathy on the emotional state and which factors are associated with changes in the emotional state in patients with cirrhosis.

Methods This single-center study included all patients with cirrhosis who underwent the portosystemic encephalopathy syndrome (PSE) test, critical flicker frequency, and emotional state assessment with the Eigenschaftswörterliste 60-S in 2011. Covert hepatic encephalopathy was defined by abnormal PSE. Parametric and non-parametric tests were used according to variable distribution.

Results One hundred seventeen patients with cirrhosis were included (median age: 59 [interquartile range: 48 – 67], 32 % female, 74 % alcohol-associated). Seventy patients had covert hepatic encephalopathy (60 %) with a higher MELD (16 [interquartile range: 13 – 21], p = 0.001) and a higher Child-Pugh score (p = 0.003) compared to patients without encephalopathy. Patients with covert encephalopathy felt reduced mental activity (p = 0.004), lower general well-being (p = 0.001), and reduced extraversion (p = 0.021). The scores in the negative domains such as general lethargy (p = 0.031) and anxiousness/depressiveness (p = 0.033) were higher in patients with covert hepatic encephalopathy. There was no correlation between MELD and the emotional state. Patients with 2 pathological tests (critical flicker frequency and PSE) showed the most distinct alterations in the emotional state in the group of patients with covert hepatic encephalopathy.

Conclusions Patients with covert hepatic encephalopathy have an alteration of the emotional state, which is more marked in patients with 2 pathological tests. Interestingly, MELD had no impact on the emotional state.

Zusammenfassung

Einleitung Die covert hepatische Enzephalopathie (CHE) führt zu vielfältigen Einschränkungen der Lebensqualität. Ihr Einfluss auf die emotionale Befindlichkeit wurde bisher nicht untersucht. Die Ziele der Studie sind, die Untersuchung des Einflusses der CHE auf die emotionale Befindlichkeit und die Evaluation der Faktoren die zu Veränderungen in der emotionalen Befindlichkeit bei Leberzirrhose assoziiert sind.

Material und Methodik In der unizentrischen Studie wurden alle Patienten mit Leberzirrhose eingeschlossen, welche mittels PSE-Syndrom-Test (PSE), der kritischen Flimmerfrequenz (CFF) und der Eigenschaftswörterliste 60-S zur Erfassung der emotionalen Befindlichkeit evaluiert wurden. Die CHE ist durch einen pathologischen PSE-Test definiert. Patienten mit klinisch manifester Enzephalopathie wurden ausgeschlossen.

Ergebnisse 117 Patienten wurden eingeschlossen [Alter 59 (IQR 48 – 67) Jahre; 32 % weiblich; 74 % alkoholische Genese]. 70 Patienten hatten eine CHE (60 %) mit höherem MELD [16 (IQR 13 – 21); p = 0.001] und höherem Child-Pugh-Score (p = 0.003) als Patienten ohne hepatische Enzephalopathie. Patienten mit CHE fühlten eine reduzierte leistungsbezogene Aktivität (p = 0.004), ein reduziertes allgemeines Wohlbefinden (p = 0.001) und eine verminderte Extraversion (p = 0.021) im Vergleich zu nicht erkrankten Patienten. Die Punktzahl in den negativen Domänen allgemeine Desaktivität (p = 0.031) und Angst/Deprimiertheit (p = 0.033) war höher bei CHE-Patienten. Es gab keine Korrelationen zwischen MELD und der emotionalen Befindlichkeit. Patienten mit zwei pathologischen Testergebnissen (CFF und PSE) wiesen die stärksten negativen Veränderungen der emotionalen Befindlichkeit auf.

Zusammenfassung Bei CHE-Erkrankten kommt es zu negativen Veränderungen der emotionalen Befindlichkeit, welche bei Patienten mit zwei pathologischen diagnostischen Tests (CFF und PSE) am deutlichsten sind. Der Schweregrad der Lebererkrankung gemessen mittels MELD hat keinen Einfluss auf die emotionale Befindlichkeit.

Key words

hepatic encephalopathy - cirrhosis - quality of life - diagnosis

Schlüsselwörter

Leberzirrhose - Hepatische Enzephalopathie - Lebensqualität - Diagnose

* Shared first authorship.


 

  • References

  • 1 Dhiman RK, Saraswat V, Duseja A. et al. MHE. Consensus statement of a working party of the Indian national association for study of the liver. J Gastroenterol Hepatol 2010; 25: 1029-1041
    CrossrefPubMedGoogle Scholar
  • 2 Dhiman RK, Chawla YK. Minimal hepatic encephalopathy. Indian J Gastroenterol 2009; 28: 5-16
    CrossrefPubMedGoogle Scholar
  • 3 Roman E, Cordoba J, Torrens M. et al. Minimal hepatic encephalopathy is associated with falls. Am J Gastroenterol 2011; 106: 476-482
    CrossrefPubMedGoogle Scholar
  • 4 Samanta J, Dhiman RK, Khatri A. et al. Correlation between degree and quality of sleep disturbance and the level of neuropsychiatric impairment in patients with liver cirrhosis. Metab Brain Dis 2013; 28: 249-259
    CrossrefPubMedGoogle Scholar
  • 5 Córdoba J, Cabrera J, Lataif L. et al. High prevalence of sleep disturbance in cirrhosis. Hepatology 1998; 27: 339-345
    CrossrefPubMedGoogle Scholar
  • 6 Bajaj JS, Saeian K, Schubert CM. et al. Minimal hepatic encephalopathy is associated with motor vehicle crashes: the reality beyond the driving test. Hepatology 2009; 50: 1175-1183
    CrossrefPubMedGoogle Scholar
  • 7 Bajaj JS, Hafeezullah M, Hoffmann RG. et al. Minimal hepatic encephalopathy: a vehicle for accidents and traffic violations. Am J Gastroenterol 2007; 102: 1903-1909
    CrossrefPubMedGoogle Scholar
  • 8 Sanyal A, Younossi ZM, Bass NM. et al. Randomised clinical trial: rifaximin improves health-related quality of life in cirrhotic patients with hepatic encephalopathy – a double-blind placebo-controlled study. Aliment Pharmacol Ther 2011; 34: 853-861
    CrossrefPubMedGoogle Scholar
  • 9 Ong JP, Oehler G, Krüger-Jansen C. et al. Oral L-ornithine-L-aspartate improves health-related quality of life in cirrhotic patients with hepatic encephalopathy: an open-label, prospective, multicentre observational study. Clin Drug Investig 2011; 31: 213-220
    CrossrefPubMedGoogle Scholar
  • 10 Prasad S, Dhiman RK, Duseja A. et al. Lactulose improves cognitive functions and health-related quality of life in cirrhotic patients with minimal hepatic encephalopathy. Hepatology 2007; 45: 549-559
    CrossrefPubMedGoogle Scholar
  • 11 Mittal VV, Sharma BC, Sharma P. et al. A randomized controlled trial comparing lactulose, probiotics, and L-ornithine L-aspartate in treatment of minimal hepatic encephalopathy. Eur J Gastroenterol Hepatol 2011; 23: 725-732
    CrossrefPubMedGoogle Scholar
  • 12 Groeneweg M, Quero JC, De Bruijn I. et al. Subclinical hepatic encephalopathy impairs daily functioning. Hepatology 1998; 28: 45-49
    CrossrefPubMedGoogle Scholar
  • 13 Bao ZJ, Qiu DK, Ma X. et al. Assessment of health-related quality of life in Chinese patients with minimal hepatic encephalopathy. World J Gastroenterol 2007; 13: 3003-3008
    CrossrefPubMedGoogle Scholar
  • 14 Mina A, Moran S, Ortiz-Olvera N. et al. Prevalence of minimal hepatic encephalopathy and quality of life in patients with decompensated cirrhosis. Hepatol Res 2014; 44: E92-E99
    CrossrefPubMedGoogle Scholar
  • 15 Arguedas MR, DeLawrence TG, McGuire BM. Influence of hepatic encephalopathy on health – related quality of life in patients with cirrhosis. Dig Dis Sci 2003; 48: 1622-1626
    CrossrefPubMedGoogle Scholar
  • 16 Younossi ZM, Guyatt G, Kiwi M. et al. Development of a disease specific questionnaire to measure health related quality of life in patients with chronic liver disease. Gut 1999; 45: 295-300
    CrossrefPubMedGoogle Scholar
  • 17 Kalaitzakis E, Josefsson A andBjörnsson E. Type and etiology of liver cirrhosis are not related to the presence of hepatic encephalopathy or health-related quality of life: a cross-sectional study BMC Gastroenterol. 2008; 8: 46
    PubMedGoogle Scholar
  • 18 Haas BK. A multidisciplinary concept analysis of quality of life. West J Nurs Res 1999; 21: 728-742
    CrossrefPubMedGoogle Scholar
  • 19 Mandzuk L, McMillan D. A concept analysis of quality of life. J Orthop Nurs 2005; 9: 12-18
    CrossrefPubMedGoogle Scholar
  • 20 Schipper H, Clinch JJ, Olweny CHLM. Quality of life studies: definitions and conceptual issues. In: Spilker B. ed Quality of Life and Pharmacoeconomics in Clinical Trials. Philadelphia: Lippincott-Raven; 1996: 11-24
    Google Scholar
  • 21 Bakas T, McLennon SM, Carpenter JS. et al. Systematic review of health-related quality of life models. Health Qual Life Outcomes 2012; 10: 134
    CrossrefPubMedGoogle Scholar
  • 22 Tarlov AR, Ware JE Jr, Greenfield S. et al. The Medical Outcomes Study. An application of methods for monitoring the results of medical care. JAMA 1989; 262: 925-930
    CrossrefPubMedGoogle Scholar
  • 23 Hays RD, Sherbourne CD, Mazel RM. The RAND 36-Item Health Survey 1.0. Health Econ 1993; 2: 217-227
    Google Scholar
  • 24 Bergner M, Bobbitt RA, Carter WB. et al. The Sickness Impact Profile: development and final revision of a health status measure. Med Care 1981; 19: 787-805
    CrossrefPubMedGoogle Scholar
  • 25 Sembill D. Problemlösefähigkeit, Handlungskompetenz und Emotionale Befindlichkeit. Zielgrößen Forschenden Lernens. Göttingen, Zürich: Hogrefe; 1992: 118
    Google Scholar
  • 26 Janke W, Debus G. Die Eigenschaftswörterliste EWL. Göttingen: Hogrefe Verlag; 1978
    Google Scholar
  • 27 Janke W, Debus G. et al. EWL Eigenschaftwörterliste. In: Schumacher J, Klaiberg A, Brähler E, eds. Diagnostische Verfahren zu Lebensqualität und Wohlbefinden. Göttingen. Bern: Hogrefe; 2003: 92-96
    Google Scholar
  • 28 Otto JH, Schmitz BB. Changes in positive mood states by analytic and creative information processing. Z Exp Angew Psychol 1993; 40: 235-266
    PubMedGoogle Scholar
  • 29 Schubert C, Geser W, Noisternig B. et al. Stress system dynamics during “life as it is lived”: an integrative single-case study on a healthy woman. PLoS One 2012; 7: e29415
    CrossrefPubMedGoogle Scholar
  • 30 Laux G, Lesch KP, Schwab M. Psychotropic effects of corticotropin-releasing hormone stimulation in depressive patients. Neuropsychobiology 1988; 19: 40-44
    CrossrefPubMedGoogle Scholar
  • 31 Frey R, Decker K, Reinfried L. et al. Effect of rest on physicians’ performance in an emergency department, objectified by electroencephalographic analyses and psychometric tests. Crit Care Med 2002; 30: 2322-2329
    CrossrefPubMedGoogle Scholar
  • 32 Stevens PE, Levin A. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med 2013; 158: 825-830
    CrossrefPubMedGoogle Scholar
  • 33 Schomerus H, Hamster W. Neuropsychological aspects of portal-systemic encephalopathy. Metab Brain Dis 1998; 13: 361-377
    CrossrefPubMedGoogle Scholar
  • 34 Schomerus H, Weissenborn K, Hamster W. et al. PSE-Syndrom-Test Swets Test Services. Frankfurt: Swets & Zeitlinger; 1999
    Google Scholar
  • 35 Greinert R, Ripoll C, Hollenbach M. et al. Stepwise diagnosis in covert hepatic encephalopathy: critical flicker frequency and MELD-score as a first-step approach. Aliment Pharmacol Ther 2016; 44: 514-521
    CrossrefPubMedGoogle Scholar
  • 36 Vilstrup H, Amodio P, Bajaj J. et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology 2014; 60: 715-735
    CrossrefPubMedGoogle Scholar
  • 37 Kircheis G, Hilger N, Häussinger D. Value of critical flicker frequency and psychometric hepatic encephalopathy score in diagnosis of low-grade hepatic encephalopathy. Gastroenterology 2014; 146: 961-969
    CrossrefPubMedGoogle Scholar