Covert hepatic encephalopathy: Agreement and predictive validity of different indices

• Published in: World journal of gastroenterology : WJG 2014-11, Vol.20 (42), p.15756-15762
• Main Authors: Montagnese, Sara, Balistreri, Esmeralda, Schiff, Sami, De Rui, Michele, Angeli, Paolo, Zanus, Giacomo, Cillo, Umberto, Bombonato, Giancarlo, Bolognesi, Massimo, Sacerdoti, David, Gatta, Angelo, Merkel, Carlo, Amodio, Piero
• Format: Article
• Language: English
• Subjects: Aged; Asymptomatic Diseases; Clinical Trials Study; Electroencepha-lography; Electroencephalography; encephalopathy; Female; Hepatic; Hepatic Encephalopathy - diagnosis; Hepatic Encephalopathy - etiology; Hepatic Encephalopathy - mortality; Hepatic Encephalopathy - physiopathology; Hepatic Encephalopathy - psychology; Hepatic Encephalopathy - therapy; Hospitalization; Humans; Kaplan-Meier Estimate; Liver Cirrhosis - complications; Liver Cirrhosis - diagnosis; Liver Cirrhosis - mortality; Liver Cirrhosis - therapy; Male; Middle Aged; Neuropsychological Tests; Observer Variation; Predictive Value of Tests; Prognosis; Psy; Psychometrics; Reproducibility of Results; Risk Factors; Severity of Illness Index; Time Factors; Ultrasonography, Doppler
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v20.i42.15756

AIM:To investigate the agreement and prognosticvalue of different measures of covert hepatic encephalopathy(CHE).METHODS:One-hundred-and-thirty-two cirrhotic outpatients underwent electroencephalography(EEG),paper-and-pencil psychometry(PHES)and critical flicker frequency,scored on the original/modified(CFFo/CFFm)thresholds.Eighty-four patients underwent Dopplerultrasound to diagnose/exclude portal-systemic shunt.Seventy-nine were followed-up for 11±7 mo in relation to the occurrence of hepatic encephalopathy(HE)-related hospitalisations.RESULTS:On the day of study,36%had gradeⅠHE,42%abnormal EEG,33%abnormal PHES and 31/21%abnormal CFFo/CFFm.Significant associations were observed between combinations of test abnormalities;however,agreement was poor(Cohen’sκ<0.4).The prevalence of EEG,PHES and CFFo/CFFm abnormalities was significantly higher in patients with gradeⅠovert HE.The prevalence of EEG and CFFm abnormalities was higher in patients with shunt.The prevalence of EEG abnormalities was significantly higher in patients with a history of HE.During follow-up,10 patients died,10were transplanted and 29 had HE-related hospitalisations.GradeⅠHE(P=0.004),abnormal EEG(P=0.008)and abnormal PHES(P=0.04)at baseline all predicted the subsequent occurrence of HE;CFF did not.CONCLUSION:CHE diagnosis probably requires a combination of clinical,neurophysiological and neuropsychological indices.