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 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.

Covert hepatic encephalopathy: Agreement and predictive validity of different indices

MONTAGNESE, SARA;SCHIFF, SAMI;ANGELI, PAOLO;ZANUS, GIACOMO;CILLO, UMBERTO;BOLOGNESI, MASSIMO;SACERDOTI, DAVID;GATTA, ANGELO;MERKEL, CARLO;AMODIO, PIERO
2014

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 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.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11577/3029503
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