Associations of metabolic syndrome with minimal hepatic encephalopathy in patients with cirrhosis and portal hypertension: a retrospective cohort study

Background and purpose Metabolic syndrome and minimal hepatic encephalopathy are both associated with impaired hepatic metabolic function. This study aimed to investigate their relationship in patients with cirrhosis and portal hypertension. Methods This retrospective cohort study enrolled 127 patients. Minimal hepatic encephalopathy was diagnosed using the Psychometric Hepatic Encephalopathy Score. Restricted cubic spline and threshold analyses were used to assess dose-response relationships. Multivariable logistic and modified Poisson regression analyses were performed to identify independent predictors. Results The prevalence of minimal hepatic encephalopathy was 17.3% (22/127). Patients with MHE had significantly higher fasting blood glucose (8.17 ± 4.36 vs. 5.33 ± 0.98 mmoL/L), and higher prevalence of metabolic syndrome and diabetes. Fasting blood glucose was an independent risk factor for MHE ( P < 0.05), and diabetes showed a similar association in a separate model. A nonlinear relationship was observed between FBG and MHE risk (P for overall = 0.006, P for nonlinear = 0.078), with an exploratory inflection point at 8.36 mmol/L. Below this threshold, each 1 mmol/L increase in glucose corresponded to a 92.1% higher risk of MHE. Spearman correlation analysis showed that higher FBG levels were associated with poorer performance on DST and SDT subtests of PHES. Multivariate regression identified older age (OR = 1.103, P = 0.007), higher Child–Pugh grade (OR = 5.869, P = 0.008), and higher FBG (OR = 1.750, P = 0.007) as independent risk factors for MHE. Conclusion Metabolic disorders, especially hyperglycemia is closely associated with the occurrence of MHE in cirrhotic patients. Blood glucose control and comprehensive metabolic management may help reduce the risk of MHE.