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Background <p>Minimal hepatic encephalopathy (MHE) is the mildest form of hepatic encephalopathy, often undetected in clinical practice, and reflects central nervous system dysfunction caused by liver disease and/or portosystemic shunting. MHE is often assessed using various diagnostic methods, including psychometric tests and electroencephalograms. The Psychometric Hepatic Encephalopathy Score (PHES) is considered the definitive diagnostic tool for MHE; however, its practical limitations have led researchers to explore noninvasive biomarkers, whose diagnostic validity remains unproven.</p> Objectives <p>This study aims to assess the role of serum neurofilament light chain (NFLC) levels as an early diagnostic biomarker for MHE in patients with liver cirrhosis (LC) before progression to overt hepatic encephalopathy (OHE) compared to an abbreviated psychometric battery (APB) for neurocognitive assessment.</p> Patients and methods <p>This case-control study included 150 participants, divided into three equal groups: 50 cirrhotic patients with psychometric impairment consistent with MHE; 50 cirrhotic patients without psychometric impairment of MHE; and 50 healthy volunteers. All subjects provided a thorough history, underwent clinical examination, and had laboratory tests. Neurocognitive performance was assessed using an Abbreviated Psychometric Test Battery evaluating attention and psychomotor speed, and serum NFLC levels were measured with ELISA.</p> Results <p>Serum NFLC levels exhibited significant variation among the three groups, with the greatest levels in the MHE group (644.0 ± 153.1&#xa0;pg/mL), intermediate values in cirrhotic patients without MHE (318.8 ± 49.7&#xa0;pg/mL), and the lowest levels in healthy controls (61.1 ± 16.5&#xa0;pg/mL). At a cutoff point of &gt; 420 pg/mL, serum NFLC predicted MHE with 98.0% sensitivity, 96.0% specificity, 96.1% positive predictive value (PPV), and 98.0% negative predictive value (NPV). The area under the curve (AUC) was 0.996 (<i>p</i> &lt; 0.001).</p> Conclusion <p>Elevated NFLC levels were linked to psychometric impairment consistent with MHE and had a significant inverse correlation with the APB score. This suggests that NFLC may be effective for early identification of MHE.</p>

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Serum levels of neurofilament light chains in the detection of minimal hepatic encephalopathy in patients with liver cirrhosis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月2日

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  • Moamena S. Elhamouly,
  • Hosam E. Seleem,
  • Sara M. El- Deeb,
  • Eman M. Arab,
  • Amany Abas Amer

摘要

Background

Minimal hepatic encephalopathy (MHE) is the mildest form of hepatic encephalopathy, often undetected in clinical practice, and reflects central nervous system dysfunction caused by liver disease and/or portosystemic shunting. MHE is often assessed using various diagnostic methods, including psychometric tests and electroencephalograms. The Psychometric Hepatic Encephalopathy Score (PHES) is considered the definitive diagnostic tool for MHE; however, its practical limitations have led researchers to explore noninvasive biomarkers, whose diagnostic validity remains unproven.

Objectives

This study aims to assess the role of serum neurofilament light chain (NFLC) levels as an early diagnostic biomarker for MHE in patients with liver cirrhosis (LC) before progression to overt hepatic encephalopathy (OHE) compared to an abbreviated psychometric battery (APB) for neurocognitive assessment.

Patients and methods

This case-control study included 150 participants, divided into three equal groups: 50 cirrhotic patients with psychometric impairment consistent with MHE; 50 cirrhotic patients without psychometric impairment of MHE; and 50 healthy volunteers. All subjects provided a thorough history, underwent clinical examination, and had laboratory tests. Neurocognitive performance was assessed using an Abbreviated Psychometric Test Battery evaluating attention and psychomotor speed, and serum NFLC levels were measured with ELISA.

Results

Serum NFLC levels exhibited significant variation among the three groups, with the greatest levels in the MHE group (644.0 ± 153.1 pg/mL), intermediate values in cirrhotic patients without MHE (318.8 ± 49.7 pg/mL), and the lowest levels in healthy controls (61.1 ± 16.5 pg/mL). At a cutoff point of > 420 pg/mL, serum NFLC predicted MHE with 98.0% sensitivity, 96.0% specificity, 96.1% positive predictive value (PPV), and 98.0% negative predictive value (NPV). The area under the curve (AUC) was 0.996 (p < 0.001).

Conclusion

Elevated NFLC levels were linked to psychometric impairment consistent with MHE and had a significant inverse correlation with the APB score. This suggests that NFLC may be effective for early identification of MHE.