Determination of Turkish norms of psychometric tests for diagnosing minimal hepatic encephalopathy and proposal of a high sensitive screening test battery.
Cirrhosis
Critical flicker frequency
Minimal hepatic encephalopathy
Portosystemic hepatic encephalopathy score
Turkish norms
Journal
Hepatology international
ISSN: 1936-0541
Titre abrégé: Hepatol Int
Pays: United States
ID NLM: 101304009
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
received:
01
02
2021
accepted:
30
04
2021
pubmed:
5
6
2021
medline:
15
12
2021
entrez:
4
6
2021
Statut:
ppublish
Résumé
Psychometric hepatic encephalopathy score (PHES) needs local standardization. This study aimed at standardizing PHES for Turkish patients and compare them with German norms; to determine minimal hepatic encephalopathy (mHE) prevalence with two different methods [PHES battery and Critical Flicker Frequency (CFF)] and to assess whether sub-tests of the battery can be used for screening for mHE. Healthy volunteers (n = 816; 400 male) and cirrhotics (n = 124; 58 male) were included. For mHE diagnosis PHES score threshold was set at ≤ - 5 points and that of CFF at < 39 Hz. For comparing German and Turkish norms, datasets were combined. Multiple backward procedure was applied to assess effects of age, sex and education on single tests of the battery. Receiver operating characteristic (ROC) curves were created for assessing diagnostic capabilities of subtests of the battery. PHES norms for Turks were developed. MHE prevalence in compensated cirrhotics was 29.8% and 27.4% with PHES and CFF tests, respectively, with low compatibility (kappa coefficient 0.389); mHE prevalence decreased to 16% when both tests were combined. Turks performed worse vs Germans in the digit symbol (DS) and serial dotting (SD) subtests but performed better in other subtests. In ROC analyzes of subtests, the combination of DS + SD tests achieved an AUROC of 0.974 versus PHES. Use of two methods for diagnosing mHE is important for research purposes. From a clinical perspective, sensitivity with acceptable specificity may suffice for screening instruments for mHE. Combined use of DS and SD subtests of the PHES battery appears suitable for this purpose.
Sections du résumé
BACKGROUND
BACKGROUND
Psychometric hepatic encephalopathy score (PHES) needs local standardization.
AIMS
OBJECTIVE
This study aimed at standardizing PHES for Turkish patients and compare them with German norms; to determine minimal hepatic encephalopathy (mHE) prevalence with two different methods [PHES battery and Critical Flicker Frequency (CFF)] and to assess whether sub-tests of the battery can be used for screening for mHE.
METHODS
METHODS
Healthy volunteers (n = 816; 400 male) and cirrhotics (n = 124; 58 male) were included. For mHE diagnosis PHES score threshold was set at ≤ - 5 points and that of CFF at < 39 Hz. For comparing German and Turkish norms, datasets were combined. Multiple backward procedure was applied to assess effects of age, sex and education on single tests of the battery. Receiver operating characteristic (ROC) curves were created for assessing diagnostic capabilities of subtests of the battery.
RESULTS
RESULTS
PHES norms for Turks were developed. MHE prevalence in compensated cirrhotics was 29.8% and 27.4% with PHES and CFF tests, respectively, with low compatibility (kappa coefficient 0.389); mHE prevalence decreased to 16% when both tests were combined. Turks performed worse vs Germans in the digit symbol (DS) and serial dotting (SD) subtests but performed better in other subtests. In ROC analyzes of subtests, the combination of DS + SD tests achieved an AUROC of 0.974 versus PHES.
CONCLUSIONS
CONCLUSIONS
Use of two methods for diagnosing mHE is important for research purposes. From a clinical perspective, sensitivity with acceptable specificity may suffice for screening instruments for mHE. Combined use of DS and SD subtests of the PHES battery appears suitable for this purpose.
Identifiants
pubmed: 34085147
doi: 10.1007/s12072-021-10207-5
pii: 10.1007/s12072-021-10207-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1442-1455Informations de copyright
© 2021. Asian Pacific Association for the Study of the Liver.
Références
Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology 2014;60(2):715–735
pubmed: 25042402
Ridola L, Cardinale V, Riggio O. The burden of minimal hepatic encephalopathy: from diagnosis to therapeutic strategies. Ann Gastroenterol 2018;31(2):151–164
pubmed: 29507462
pmcid: 5825945
Morgan MY, Amodio P, Cook NA, Jackson CD, Kircheis G, Lauridsen MM, et al. Qualifying and quantifying minimal hepatic encephalopathy. Metab Brain Dis 2016;31(6):1217–1229
pubmed: 26412229
Groeneweg M, Quero JC, De Bruijn I, Hartmann IJ, Essink-bot ML, Hop WC, et al. Subclinical hepatic encephalopathy impairs daily functioning. Hepatology 1998;28(1):45–49
pubmed: 9657095
Agrawal S, Umapathy S, Dhiman RK. Minimal hepatic encephalopathy impairs quality of life. J Clin Exp Hepatol 2015;5(Suppl 1):S42–S48
pubmed: 26041957
Schomerus H, Hamster W. Quality of life in cirrhotics with minimal hepatic encephalopathy. Metab Brain Dis 2001;16(1–2):37–41
pubmed: 11726087
Wein C, Koch H, Popp B, Oehler G, Schauder P. Minimal hepatic encephalopathy impairs fitness to drive. Hepatology 2004;39(3):739–745
pubmed: 14999692
Bajaj JS, Ananthakrishnan AN, McGinley EL, Hoffman RG, Brasel KJ. Deleterious effect of cirrhosis on outcomes after motor vehicle crashes using the nationwide inpatient sample. Am J Gastroenterol 2008;103(7):1674–1681
pubmed: 18616657
Kircheis G, Knoche A, Hilger N, Manhart F, Schnitzler A, Schulze H, et al. Hepatic encephalopathy and fitness to drive. Gastroenterology 2009;137(5):1706–1715 (e1–e9)
pubmed: 19686744
Das A, Dhiman RK, Saraswat VA, Verma M, Naik SR. Prevalence and natural history of subclinical hepatic encephalopathy in cirrhosis. J Gastroenterol Hepatol 2001;16(5):531–535
pubmed: 11350549
Romero-Gomez M, Boza F, Garcia-Valdecasas MS, Garcia E, Aguilar-Reina J. Subclinical hepatic encephalopathy predicts the development of overt hepatic encephalopathy. Am J Gastroenterol 2001;96(9):2718–2723
pubmed: 11569701
Amodio P, Del Piccolo F, Marchetti P, Angeli P, Iemmolo R, Caregaro L, et al. Clinical features and survivial of cirrhotic patients with subclinical cognitive alterations detected by the number connection test and computerized psychometric tests. Hepatology 1999;29(6):1662–1667
pubmed: 10347105
Ampuero J, Simon M, Montoliu C, Jover R, Serra MA, Cordoba J, et al. Minimal hepatic encephalopathy and critical flicker frequency are associated with survival of patients with cirrhosis. Gastroenterology 2015;149(6):1483–1489
pubmed: 26299413
Quero JC, Hartmann IJ, Meulstee J, Hop WC, Schalm SW. The diagnosis of subclinical hepatic encephalopathy in patients with cirrhosis using neuropsychological tests and automated electroencephalogram analysis. Hepatology 1996;24(3):556–560
pubmed: 8781324
Groeneweg M, Moerland W, Quero JC, Hop WC, Krabbe PF, Schalm SW. Screening of subclinical hepatic encephalopathy. J Hepatol 2000;32(5):748–753
pubmed: 10845661
Lee Y, Kim C, Suk KT, Choi HC, Bang CS, Yoon JH, et al. Differences in cognitive function between patients with viral and alcoholic compensated liver cirrhosis. Metab Brain Dis 2016;31(2):369–376
pubmed: 26563125
Weissenborn K, Ennen JC, Schomerus H, Ruckert N, Hecker H. Neuropsychological characterization of hepatic encephalopathy. J Hepatol 2001;34(5):768–773
pubmed: 11434627
Lauridsen MM, Thiele M, Kimer N, Vilstrup H. The continuous reaction times method for diagnosing, grading, and monitoring minimal/covert hepatic encephalopathy. Metab Brain Dis 2013;28(2):231–234
pubmed: 23299303
Bajaj JS, Hafeezullah M, Franco J, Varma RR, Hoffmann RG, Knox JF, et al. Inhibitory control test for the diagnosis of minimal hepatic encephalopathy. Gastroenterology 2008;135(5):1591–1600 (e1)
pubmed: 18723018
Bajaj JS, Thacker LR, Heuman D, Fuchs M, Sterling RK, Sanyal AJ, et al. The Stroop smartphone application is a short and valid method to screen for minimal hepatic encephalopathy. Hepatology 2013;58(3):1122–1132
pubmed: 23389962
Kircheis G, Wettstein M, Timmermann L, Schnitzler A, Haussinger D. Critical flicker frequency for quantification of low-grade hepatic encephalopathy. Hepatology 2002;35(2):357–366
pubmed: 11826409
Bajaj JS, Cordoba J, Mullen KD, Amodio P, Shawcross DL, Butterworth RF, et al. Review article: the design of clinical trials in hepatic encephalopathy—an International Society for Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN) consensus statement. Aliment Pharmacol Ther 2011;33(7):739–747
pubmed: 21306407
pmcid: 3971432
Haussinger D, Laubenberger J, vom Dahl S, Ernst T, Bayer S, Langer M, et al. Proton magnetic resonance spectroscopy studies on human brain myo-inositol in hypo-osmolarity and hepatic encephalopathy. Gastroenterology 1994;107(5):1475–1480
pubmed: 7926510
Singhal A, Nagarajan R, Hinkin CH, Kumar R, Sayre J, Elderkin-Thompson V, et al. Two-dimensional MR spectroscopy of minimal hepatic encephalopathy and neuropsychological correlates in vivo. J Magn Reson Imaging 2010;32(1):35–43
pubmed: 20578008
Razek AA, Abdalla A, Ezzat A, Megahed A, Barakat T. Minimal hepatic encephalopathy in children with liver cirrhosis: diffusion-weighted MR imaging and proton MR spectroscopy of the brain. Neuroradiology 2014;56(10):885–891
pubmed: 25060166
Schomerus H, Hamster W. Neuropsychological aspects of portal-systemic encephalopathy. Metab Brain Dis 1998;13(4):361–377
pubmed: 10206827
Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT. Hepatic encephalopathy—definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology 2002;35(3):716–721
pubmed: 11870389
Amodio P, Campagna F, Olianas S, Iannizzi P, Mapelli D, Penzo M, et al. Detection of minimal hepatic encephalopathy: normalization and optimization of the Psychometric Hepatic Encephalopathy Score. A neuropsychological and quantified EEG study. J Hepatol 2008;49(3):346–353
pubmed: 18602716
Romero Gomez M, Cordoba J, Jover R, del Olmo J, Fernandez A, Flavia M, et al. Normality tables in the Spanish population for psychometric tests used in the diagnosis of minimal hepatic encephalopathy. Med Clin (Barc) 2006;127(7):246–249
Wunsch E, Koziarska D, Kotarska K, Nowacki P, Milkiewicz P. Normalization of the psychometric hepatic encephalopathy score in Polish population. A prospective, quantified electroencephalography study. Liver Int 2013;33(9):1332–1340
pubmed: 23651263
Seo YS, Yim SY, Jung JY, Kim CH, Kim JD, Keum B, et al. Psychometric hepatic encephalopathy score for the detection of minimal hepatic encephalopathy in Korean patients with liver cirrhosis. J Gastroenterol Hepatol 2012;27(11):1695–1704
pubmed: 22743001
Duarte-Rojo A, Estradas J, Hernandez-Ramos R, Ponce-de-Leon S, Cordoba J, Torre A. Validation of the psychometric hepatic encephalopathy score (PHES) for identifying patients with minimal hepatic encephalopathy. Dig Dis Sci 2011;56(10):3014–3023
pubmed: 21461913
Romero-Gomez M, Cordoba J, Jover R, del Olmo JA, Ramirez M, Rey R, et al. Value of the critical flicker frequency in patients with minimal hepatic encephalopathy. Hepatology 2007;45(4):879–885
pubmed: 17393525
Goldbecker A, Weissenborn K, Hamidi Shahrezaei G, Afshar K, Rumke S, Barg-Hock H, et al. Comparison of the most favoured methods for the diagnosis of hepatic encephalopathy in liver transplantation candidates. Gut 2013;62(10):1497–1504
pubmed: 23297006
Dhiman RK, Kurmi R, Thumburu KK, Venkataramarao SH, Agarwal R, Duseja A, et al. Diagnosis and prognostic significance of minimal hepatic encephalopathy in patients with cirrhosis of liver. Dig Dis Sci 2010;55(8):2381–2390
pubmed: 20508990
American Association for the Study of Liver Diseases, European Association for the Study of the Liver. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases. J Hepatol 2014;61(3):642–659
Kircheis G, Hilger N, Haussinger D. Value of critical flicker frequency and psychometric hepatic encephalopathy score in diagnosis of low-grade hepatic encephalopathy. Gastroenterology 2014;146(4):961–969
pubmed: 24365582
Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 1983;148(3):839–843
pubmed: 6878708
Bajaj JS, Etemadian A, Hafeezullah M, Saeian K. Testing for minimal hepatic encephalopathy in the United States: an AASLD survey. Hepatology 2007;45(3):833–834
pubmed: 17326210
Schomerus H, Weissenborn K, Hamster W, RuÈckert N, Hecker H. PSE-Syndrom-Test Swets Test Services. Frankfurt: Swets & Zeitlinger; 1999
Riggio O, Ridola L, Pasquale C, Pentassuglio I, Nardelli S, Moscucci F, et al. A simplified psychometric evaluation for the diagnosis of minimal hepatic encephalopathy. Clin Gastroenterol Hepatol 2011;9(7):613–616 (e1)
pubmed: 21440091
Campagna F, Montagnese S, Ridola L, Senzolo M, Schiff S, De Rui M, et al. The animal naming test: an easy tool for the assessment of hepatic encephalopathy. Hepatology 2017;66(1):198–208
pubmed: 28271528
Barbosa M, Marinho C, Mota P, Cotter J. Minimal hepatic encephalopathy: the reality beyond our eyes. Acta Med Port 2015;28(4):480–485
pubmed: 26574984
Torlot FJ, McPhail MJ, Taylor-Robinson SD. Meta-analysis: the diagnostic accuracy of critical flicker frequency in minimal hepatic encephalopathy. Aliment Pharmacol Ther 2013;37(5):527–536
pubmed: 23293917
pmcid: 3761188