Prospective evaluation of the impact of covert hepatic encephalopathy on quality of life and sleep in cirrhotic patients

Summary Background Minimal hepatic encephalopathy ( HE ) and HE grade 1 ( HE 1) according to the West Haven criteria have recently been grouped as one entity named—covert HE ‐ ( CHE ). Data regarding the impact of CHE on health‐related quality of life ( HRQ oL) and sleep quality are controversial. Aim First, to determine whether CHE affects HRQ oL and sleep quality of cirrhotic patients and second, whether minimal HE ( MHE ) and HE 1 affect HRQ oL and sleep quality to a comparable extent. Methods A total of 145 consecutive cirrhotic patients were enrolled. HE 1 was diagnosed clinically according to the West Haven criteria. Critical flicker frequency and the Psychometric Hepatic Encephalopathy Score were used to detect MHE . Chronic Liver Disease Questionnaire ( CLDQ ) was used to assess HRQ oL and Pittsburgh Sleep Quality Index ( PSQI ) was applied to assess sleep quality. Results Covert HE was detected in 59 (40.7%) patients ( MHE : n = 40; HE 1: n = 19). Multivariate analysis identified CHE ( P < 0.001) and female gender ( P = 0.006) as independent predictors of reduced HRQ oL ( CLDQ total score). CHE ( P = 0.021), low haemoglobin ( P = 0.024) and female gender ( P = 0.003) were identified as independent predictors of poor sleep quality ( PSQI total score). Results of CLDQ and PSQI were comparable in patients with HE 1 and MHE ( CLDQ : 4.6 ± 0.9 vs 4.5 ± 1.2, P = 0.907; PSQI : 11.3 ± 3.8 vs 9.9 ± 5.0, P = 0.3). Conclusion Covert HE was associated with impaired HRQ oL and sleep quality. MHE and HE 1 affected both outcomes to a comparable extent supporting the use of CHE as a clinically useful term for patients with both entities of HE in clinical practice.