Association between road accidents and minimal hepatic encephalopathy in a cohort of Sri Lankan drivers with cirrhosis

Abstract

INTRODUCTION AND OBJECTIVES: Minimal hepatic encephalopathy (MHE) has no recognizable clinical symptoms of hepatic encephaiopathy (HE) but has mild cognitive and psychomotor deficits. Previous studies in Western countries have demonstrated an association between MHE and increased road accidents. Our objective was to investigate this association in a cohort of Sri Lankan drivers with cirrhosis. Study design; Prospective, case controlled study. Study setting; Ongoing study conducted in the Gastroenterology Clinic, University Medical Unit, North Colombo Teaching Hospital, Ragama, from August 2013. METHODS: Patients with cirrhosis of any aetiology, without overt HE, who had been driving any vehicle during the past one month were subjected to 5 standard pencil-paper based psychometric tests to detect MHE. An abnormality in 3 or more tests was considered diagnostic of MHE. Road accidents were recorded among drivers with cirrhosis with MHE. Age and sex matched healthy drivers (controls) who also underwent the 5 psychometric tests. RESULTS: Among 54 drivers with cirrhosis with MHE [males, median age 53 years (range 30-60}], 7 (13%) reported any type of accident compared to 6 (11%) among 54 controls [males; median age 51 years (range 30-60)]. 2 (3.7%) cases and 2 (3.7%) controls reported minor accidents involving another person. There were no major accidents in either group. CONCLUSIONS: Preliminary results of this ongoing study do not indicate an increased frequency of road accidents in a cohort of Sri Lankan drivers with cirrhosis with MHE.