Evaluation of clinical nutritional status and correlation factors in patients with cirrhosis complicated with minimal hepatic encephalopathy

Objective To evaluate the incidence of clinical malnutrition in patients with cirrhosis combined with minimal hepatic encephalopathy (MHE) and analyze the predictive factors for the occurrence of MHE in cirrhosis patients.

Methods Relevant data of hospitalized patients diagnosed with cirrhosis was collected. Dominant grip strength, number connectivity test (NCT)-A, number symbol test (DST), and animal naming test (ANT) tests on them were conducted. According to the test results, they were divided into MHE group and N-MHE group based on the presence or absence of hepatic encephalopathy. The test results were recorded and clinical data was collected. The psoas major muscle thickness (TPMT) at the central plane of the right third lumbar vertebral body (L₃) and the umbilical horizontal plane in the mid-abdominal CT plain scan images were measured, and then compared with height (TPMT/H) to evaluate the diagnostic value of TPMT/H for malnutrition and MHE, and its optimal critical value was established.

Results A total of 114 patients with cirrhosis were included, and the incidence of MHE was 28.07% (32/114). The dominant grip strength and TPMT/H ratio in the MHE group were lower than those in the N-MHE group (P < 0.01), and there were statistically significant differences in TPMT/H between the L₃ and umbilical planes between the two groups (P < 0.01). Binary logistic regression analysis confirmed that plasma ammonia and right umbilical plane TPMT/H were independent risk factors for MHE during hospitalization (P < 0.05). ROC curve analysis showed that the area under the plasma ammonia curve was significantly lower than that of TPMT/H. The umbilical plane TPMT/H was strongly correlated with dominant hand grip strength (r=0.629, P < 0.01), while the L₃ plane TPMT/H was moderately correlated with dominant hand grip strength (r=0.541, P < 0.01).

Conclusions Muscle loss is closely related to the occurrence of MHE in cirrhosis patients, and measuring TPMT/H (right umbilical horizontal plane) can help predict the occurrence of MHE in cirrhosis patients.