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Minimal hepatic encephalopathy (MHE) is a covert form of hepatic encephalopathy associated with cognitive and psychomotor impairment in patients with compensated liver cirrhosis. Early detection of MHE is crucial to prevent progression to overt encephalopathy. The Psychometric Hepatic Encephalopathy Score (PHES) is a validated neuropsychological test battery for diagnosing MHE. This study aims to screen for MHE among compensated cirrhotic patients using PHES and to compare performance with healthy matched controls.
This cross-sectional case-control study will include compensated cirrhotic patients aged 18-70 years attending Sohag University Hospital, as well as a control group of healthy volunteers matched for age and education. All participants will undergo clinical evaluation, laboratory investigations, abdominal ultrasound, and psychometric assessment using the PHES battery (NCT-A, NCT-B, DST, SDT, LTT). PHES performance will be compared between cases and controls. The diagnostic accuracy of PHES for detecting MHE will be evaluated using sensitivity, specificity, PPV, NPV, and AUROC. Correlation analyses will explore associations between PHES scores and liver disease severity.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group 1: Cirrhotic Patients (Cases) | Compensated cirrhotic patients aged 18-70 years undergoing Psychometric hepatic encephalopathy score testing. |
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| Group 2: Healthy Volunteers (Controls) | Healthy adults aged 18-70 years with no chronic disease and normal cognitive function undergoing Psychometric hepatic encephalopathy score testing. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Psychometric Hepatic Encephalopathy Score (PHES) | Other | A standardized paper-and-pencil neuropsychological test battery used to detect minimal hepatic encephalopathy. It includes:
Tests are administered in a quiet environment between 8 AM and 3 PM by trained personnel. Performance is recorded as completion time, error score, or point score depending on test type. |
| Measure | Description | Time Frame |
|---|---|---|
| Detection rate of minimal hepatic encephalopathy using PHES | Proportion of compensated cirrhotic patients classified as having minimal hepatic encephalopathy based on PHES total score and normative regression equations. | Baseline assessment |
| Measure | Description | Time Frame |
|---|---|---|
| Comparison of PHES subtest performance between cirrhotic patients and healthy controls | Differences in NCT-A, NCT-B, DST, SDT, and LTT scores between groups. | Baseline |
| Association between PHES total score and liver disease severity |
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Inclusion Criteria:
Inclusion Criteria (Cirrhotic Patients):
Age 18-70 years.
Diagnosed compensated liver cirrhosis, regardless of etiology.
Able to read and write.
Adequate vision, hearing, and physical ability to perform the PHES tests.
Inclusion Criteria (Healthy Controls):
Age 18-70 years.
No chronic medical, neurological, psychiatric, renal, or cardiac disease.
Able to read and write.
Adequate cognition, hearing, vision, and physical ability.
Exclusion Criteria:
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Group 1: Cirrhotic Patients (Cases)
Compensated cirrhotic patients aged 18-70 years undergoing PHES testing.
Group 2: Healthy Volunteers (Controls)
Healthy adults aged 18-70 years with no chronic disease and normal cognitive function.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Sara Sabry, Resident doctor | Contact | 01005344254 | sara_sabry_post@med.sohag.edu.eg |
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De-identified participant data will be made available upon reasonable request.
6 months after publication of study results.
Data may be shared with investigators who submit a justified request via email.
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Correlation of PHES with Child-Pugh score, ALT, AST, albumin, bilirubin, INR.
| Baseline |