JOURNAL OF EVIDENCE BASED MEDICINE AND HEALTHCARE

Table of Contents

2019 Month : November Volume : 6 Issue : 46 Page : 2945-2949

Evaluation of the Role of Electro-Encephalography in the Early Diagnosis of Minimal Hepatic Encephalopathy in Patients with Cirrhosis of Liver

Arunabha Dasgupta1, Atul Debbarma2, Saroj Kumar Choudhury3

Corresponding Author:
Dr. Arunabha Dasgupta,
Associat Professor and I/C HOD,
Departmnt of General Medicine,
#22, East Thana Road, Banamalipur,
Agartala, Tripura.
E-mail: drarunabhadasgupta@gmail.com
DOI: 10.18410/jebmh/2019/614

ABSTRACT
BACKGROUND
Hepatic encephalopathy is a serious complication of cirrhosis of liver carrying high mortality rates. Two important prognostic indicators for cirrhosis are Child-Turcotte-Pugh Class (CTP-Class) & Model for Endstage Liver disease (MELD) score. Cirrhotic subjects in advanced CTP-Class & higher MELD scores have worse prognosis. Hepatic encephalopathy is one of the causes of mortality. We wanted to evaluate the role of electroencephalography in diagnosis of minimal hepatic encephalopathy in cirrhotic individuals.

METHODS
This is a case control study where 100 cirrhotic individuals who were normal in standard clinical neurological examination procedure and without any cognitive defect were included along with 100 controls selected from patient’s attendants matching with age, sex and ethnicity. All were investigated with electroencephalography and biochemical parameters for liver function tests, INR & blood ammonia. Statistical analysis was studied to identify significant correlation existing between abnormal EEG tracing suggestive of encephalopathy with CTP-Class, MELD Scores and blood ammonia level. A p value of p<0.05 was considered significant. Calculations were done with Fisher exact test.

RESULTS
Study revealed that 33% of cirrhotic individuals having electroencephalographic changes suggestive of encephalopathy as demonstrated by grading of Parson Smith et al. EEG abnormalities were correlated to advanced CTP-Class & higher MELD scores and the results are statistically significant. Estimation of blood ammonia showed a positive correlation with higher MELD scores and individuals with abnormal EEG findings too documented high blood ammonia level. Mean blood ammonia in controls is 31.1 and cirrhotic individuals with normal EEG tracing is 39.2 and with abnormal EEG of Pattern A is 45.7 and Pattern B is 49.5. With p=0.036 significant statistical correlation was documented in cirrhotic individuals with abnormal EEG and high blood ammonia level (>45). The mean MELD score in individuals with normal EEG is 12.45 and abnormal EEG is 20.36 & p=0.006. Statistically significant association was seen between EEG changes suggestive of encephalopathy and advanced MELD scores.

CONCLUSIONS
Electroencephalography is a simple diagnostic tool of low cost and easily performed which can be employed in cirrhotic individuals for diagnosis of minimal hepatic encephalopathy for adoption of preventive approaches.

KEYWORDS
Minimal hepatic encephalopathy, cirrhosis of liver, electroencephalography, blood ammonia level, CTP-Class, MELD Score