Minimal hepatic encephalopathy in hepatosplenic schistosomiasis: High prevalence and association with portosystemic shunts in a Brazilian cross-sectional study.

BACKGROUND

Hepatic encephalopathy (HE) is a poorly understood complication in hepatosplenic schistosomiasis (HSS), a neglected cause of non-cirrhotic portal hypertension. Although portosystemic shunts (PSS) are commonly observed in HSS patients, the prevalence and clinical impact of overt HE (OHE) and minimal HE (MHE) remain understudied, particularly in resource-limited settings.

AIM: To determine OHE/MHE prevalence in HSS and its associations with PSS, clinical, and laboratory characteristics.

METHODS

This cross-sectional study included 200 HSS patients undergoing treatment at the Hospital of Universidade Federal de Pernambuco in Brazil between 2021 and 2023. Cognitive function was assessed using the animal naming test (ANT) and Mini-Mental State Examination (MMSE), while psychological status was evaluated with the Hospital Anxiety and Depression Scale. PSS was identified via ultrasound, and fibrosis severity was quantified using the Coutinho index (CI). Analyses were adjusted for education level and the presence of comorbidities. Statistical analyses were performed using R software.

RESULTS

The prevalence of OHE was 0.5%, while MHE, diagnosed via ANT, affected 24% of patients. ANT positivity was significantly associated with the presence of PSS (35.1% vs 15.1%; P = 0.0018) and higher CI scores (1.79 ± 0.26 vs 1.30 ± 0.84; P = 0.045). Patients with MHE demonstrated notably lower MMSE scores (24.06 ± 1.17 vs 26.04 ± 0.63; P = 0.0003), independent of education level. The ANT showed high diagnostic robustness, even among patients with limited formal education.

CONCLUSION

MHE is prevalent in HSS, especially with PSS, and is associated with portal hypertension severity. The ANT enables practical screening, underscoring the need for routine assessment to improve outcomes.