Prevalence and risk factors of subclinical hepatic encephalopathy in patients with cirrhosis

Abstract

Background Subclinical hepatic encephalopathy (SHE) is considered an early stage of clinical encephalopathy and has been associated with shortened lifespan and increased healthcareassociated burden. We aimed to assess the prevalence of SHE in patients with cirrhosis and to elucidate the potential factors related to its occurrence.

Methods Thirty consecutive patients with cirrhosis were evaluated between March and July 2017. The exclusion criteria included overt hepatic encephalopathy, recent gastrointestinal hemorrhage, neurological disease, and the use of lactulose or non-absorbable antibiotics. After exclusion, 23 patients were included in this study. Twenty healthy age- and sex-matched controls were also included. SHE was assessed using the number connection test (NCT) and the inhibitory control test (ICT).

Results The NCT completion time was significantly longer in cirrhotic patients than in controls (77±45 vs. 27±6 sec, P<0.001), with 78.3% of cirrhotic patients showing abnormal results. ICT correct target recognition was also significantly lower in cirrhotic patients (18.5±21.8% vs. 56.2±15.8%, P<0.001), with 60.9% showing abnormal results. By combining NCT and ICT, 39.1% of patients with cirrhosis were diagnosed with SHE. No significant associations were detected between the Child-Turcotte-Pugh class or baseline parameters and the presence of SHE. At the 3-month follow up, the SHE diagnosis remained consistent, with 66.7% of those diagnosed at baseline still exhibiting SHE.

Conclusions SHE is prevalent in patients with cirrhosis and significantly affects cognitive and psychomotor abilities. Although the study sample was small, these findings highlight the necessity of regular psychometric testing in cirrhotic patients to identify and manage SHE.

Keywords Subclinical hepatic encephalopathy, cirrhosis, prevalence, risk factors

Ann Gastroenterol 2026; 39 (2): 202-207