Impact of liver cirrhosis etiology on results of diagnostic tests for minimal hepatic encephalopathy

The influence of cirrhosis etiology on minimal hepatic encephalopathy (mHE) testing and prediction of overt hepatic encephalopathy (oHE) remains unclear. We investigated the impact of cirrhosis etiology on mHE testing and its predictive value for oHE. In this observational study, 312 patients with liver cirrhosis underwent six mHE tests: Portosystemic Encephalopathy Test yielding the PHES, Animal Naming Test, Critical Flicker Frequency, Inhibitory Control Test, EncephalApp, and Continuous Reaction Time. Etiologies included alcohol-related liver disease (ALD), metabolic dysfunction-associated steatohepatitis (MASH), metabolic/alcohol-associated liver disease (MetALD), infectious/autoimmune liver disease (IALD), and cryptogenic/other (CRYO). Multivariable regression models adjusted for relevant confounders were used to analyze etiology-related differences. Predictive value for oHE was assessed over one year using competing risk models. Patients with IALD performed significantly better on PHES than ALD patients (adjusted β: 1.8, [0.5-3]). PHES scores were comparable across steatotic etiologies. PHES showed moderate predictive value for oHE in steatotic (ALD sHR: 2.2 [1.0–4.9]; MASH: 3.4 [1.3–8.8]; MetALD: 2.5 [0.8–8.0]) but strong predictive value in non-steatotic etiologies (IALD sHR: 5.7 [2.2–14.7]; CRYO: 5.8 [1.2–29.3]) Other tests showed only minor etiology-related differences. Cirrhosis etiology may influence PHES results and its predictive value for oHE.