Prevalence of hepatic encephalopathy in non-cirrhotic portal hypertension: A systematic review and meta-analysis

Abstract

Introduction and Objectives

The prevalence of hepatic encephalopathy (HE) in non-cirrhotic portal hypertension (NCPH) is not well established, despite evidence of its occurrence in both minimal (MHE) and overt forms (OHE). Accurate diagnosis and management of HE can reduce morbidity and improve patients’ and their families' quality of life. This study aimed to systematically review the prevalence of HE in NCPH.

Materials and Methods

Systematic research in five databases (MEDLINE, LILACS, MEDRXIV, SCIELO and Scopus) was carried out from January to April 2024 to detect studies that address the prevalence of MHE and OHE in patients with NCPH, using the terms: "Hepatic Encephalopathy" or "Psychometrics" or "Cognition Disorders" or "Cognition" and "Noncirrhotic Portal Hypertension".

Results

Twelve studies were included, including 575 patients. The prevalence of HE in patients with NCPH is 12 % (95 % CI: 6-24; I² 83 %, p<0.01), with high heterogeneity, with the pooled prevalence in studies evaluating MHE being 21 % (95 % CI: 11-38; I² 73 %, p<0.01) and the prevalence of OHE being 4 % (95 %CI: 1-15; I² 83 %, p<0.01). The prevalence of HE by etiology of NCPH is as follows: EHPVO is 25 % (95 %CI: 11-45; I² 0 %; p=1), PVT 2 % (95 %CI: 0-15; I² 0 %, p=1), in PSVD 8 % (95 %CI: 5-14; I² 87 %; p<0.01) and idiopathic NCPH 9 % (95 %CI: 5-14; I² 68 %, p<0.01), with the last two analyzes showing high heterogeneity.

Conclusions

HE occurs in approximately 12 % of patients with NCPH, with MHE being more common than OHE. Etiology plays a significant role in HE prevalence.