Psychometric Hepatic Encephalopathy Score detects minimal hepatic encephalopathy in cirrhosis: a hospital-based case–control study from North India

Background: Minimal hepatic encephalopathy (MHE) impairs daily functioning in cirrhosis. The Psychometric Hepatic Encephalopathy Score (PHES) is a practical bedside battery for MHE detection. Material and Methods: Hospital-based case–control study over 18 months (July 2023– December 2024), including 70 radiologically proven cirrhosis cases without overt HE and 70 age-/sex-matched healthy controls. PHES (NCT-A, NCT-B, Digit Symbol, Line Tracing, Serial Dotting) was administered; MHE = PHES <-4. EEG was performed in cases. Data were analysed with t-test/chi-square (α=0.05). Results: Mean PHES was significantly lower in cases than controls (−5.97±4.89 vs −0.21±1.39; p<0.001). MHE prevalence was 57.1% (40/70) in cases versus 1.4% (1/70) in controls. In some cases, PHES was worse in MHE than in non-MHE (−9.45±3.37 vs −1.33±1.63; p<0.001). Child-Pugh class correlated with MHE (A 28.6%, B 43.8%, C 91.7%; p=0.001). Ascites severity also correlated (mild 69.6%, moderate 76.9%, severe 100%; p<0.05). EEG was suggestive in 7 patients, all had MHE (p=0.016). Laboratory indices were higher in MHE: total bilirubin (5.78±5.71 vs 1.29±0.75 mg/dL), PT (27.29±8.17 vs 22.04±5.05 s), INR (2.01±0.77 vs 1.49±0.48); all p<0.05. Conclusion: PHES detects a high burden of MHE in cirrhosis and aligns with disease severity (Child-Pugh class, ascites), EEG abnormalities, and coagulopathy. Routine PHES screening can unmask early neurocognitive impairment and support risk-stratified care in resource-limited settings.

Keywords: Minimal hepatic encephalopathy; Psychometric Hepatic Encephalopathy Score; Cirrhosis; Child-Pugh; Ascites; EEG.