Covert hepatic encephalopathy: agreement and predictive validity of different indices.

Abstract:

AIM:To investigate the agreement and prognostic value 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 Doppler-ultrasound 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 grade I HE, 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's κ < 0.4). The prevalence of EEG, PHES and CFFo/CFFm abnormalities was significantly higher in patients with grade I overt 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, 10 were transplanted and 29 had HE-related hospitalisations. Grade I HE (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.

journal_name

World J Gastroenterol

authors

Montagnese S,Balistreri E,Schiff S,De Rui M,Angeli P,Zanus G,Cillo U,Bombonato G,Bolognesi M,Sacerdoti D,Gatta A,Merkel C,Amodio P

doi

10.3748/wjg.v20.i42.15756

subject

Has Abstract

pub_date

2014-11-14 00:00:00

pages

15756-62

issue

42

eissn

1007-9327

issn

2219-2840

journal_volume

20

pub_type

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