Original article—liver, pancreas, and biliary tractA Simplified Psychometric Evaluation for the Diagnosis of Minimal Hepatic Encephalopathy
Section snippets
Patients and Methods
From March to October 2009, all consecutive cirrhotic patients without overt HE (evaluated by the West–Haven criteria,15 the clinical HE staging scale,16 and a pool of standardized closed questions) admitted to the Gastroenterology Unit in Rome were eligible for the study. Exclusion criteria were overt HE within 15 days before the study, alcohol/psychoactive drug intake (positive alcoholemia and/or benzodiazepines or opioid urine metabolites), and unrelated neurologic disease. Although there is
Results
According to PHES, 45 patients had MHE (Table 1). In the MHE group, the number of patients with a previous history of overt HE was significantly higher (15 vs 3 patients; P = .01).
The logistic analysis showed that a model containing only DST, SDT, and LLT was similar to that containing the whole set of tests (Supplementary Table 2). The SPHES therefore was defined according to the regression coefficients and the Z scores of the 3 remaining tests (see Appendix). The rate of patients classified
Discussion
This study shows that PHES can be simplified and that TMT-A and TMT-B could be removed without a significant loss in diagnostic ability. The present study also confirms that patients with MHE are at risk of developing overt HE8, 9 and that the SPHES maintains the ability to identify these individuals. To confirm the validity of this observation, the SPHES assessment of MHE using the coefficients derived from the original group was tested in a separate group of patients. In this group, PHES and
Acknowledgments
The authors thank Professor Karin Weissenborn for the psychometric hepatic encephalopathy score forms.
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Combined Scores from the EncephalApp Stroop Test, Number Connection Test B, and Serial Dotting Test Accurately Identify Patients With Covert Hepatic Encephalopathy
2020, Clinical Gastroenterology and HepatologyCitation Excerpt :The guidelines have recommended a combination of the PHES with another test to diagnose CHE multicenter trials. Some experts had tried to streamline PHES or optimize the diagnostic strategies.2,26,27 Compared with integrated PHES, the simplified PHES (SDT+DST+LTT) has the similar potential in predicting OHE.26
Minimal Hepatic Encephalopathy
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Conflicts of interest The authors disclose no conflicts.
Funding This study was partially supported by a “Young Investigator Award” given by the Italian Society of Gastroenterology (L.R.).