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Predictors of minimal hepatic encephalopathy in patients with cirrhosis.

Abstract

BACKGROUND/AIM

Minimal hepatic encephalopathy (MHE) impairs patient's daily functioning of life. Predictors of MHE in cirrhotic patients have not been evaluated.

PATIENTS AND METHODS

A total of 200 cirrhotic patients (Child A, 74 [37%]; Child B, 72 [36%]; Child C, 54 [27%]) were evaluated by psychometry, P300 auditory event-related potential (P300ERP) and critical flicker frequency (CFF). MHE was diagnosed by abnormal psychometry (>2 S.D.) and P300ERP (>2.5 S.D.). Univariate and multivariate logistic regression analyses were performed to determine the predictors of MHE.

RESULTS

Eighty-two (41%) patients were diagnosed to have MHE - 26/74 (35%) in Child A, 26/72 (36%) in Child B and 30/54 (56%) in Child C. Ninety-seven (48.5%) patients had abnormal psychometric tests, and 96 (48%) had prolonged P300ERP (>358 ms). Sixteen (16.5%) patients with abnormal psychometry had P300ERP < 358 ms, and 15 (14.5%) patients with normal psychometry results had P300ERP > 358 ms. One hundred and three patients had CFF value < 39 Hz with specificity of 86.6% and sensitivity of 72.9% for MHE. Model for end-stage liver disease (MELD) (17.9 +/- 5.7 vs. 13.4 +/- 4.2, P = 0.005), Child-Turcotte-Pugh (CTP) score (8.4 +/- 2.5 vs. 7.7 +/- 2.2, P = 0.02), ammonia (104.8 +/- 37.9 vs. 72.5 +/- 45.2 micromol/L, P = 0.001) and CFF (37.0 +/- 2.8 vs. 41.0 +/- 3.4 Hz, P = 0.001) were significantly higher in MHE as compared to non-MHE patients. Ninety-one (45.5%) patients had MELD > 15.5, 115 (57.5%) had CTP score > 7.5, while 93 (46.5%) had venous ammonia > 84.5 micromol/L. On univariate analysis, MELD (8.52 [95% CI, 4.46-16.26; P = 0.001]), CFF (17.34 [95% CI, 8.16-36.85; P = 0.001]) and venous ammonia (7.80 [95% CI, 4.11-14.81; P = 0.003]) were associated with MHE; while CTP score (1.51 [95% CI, 0.85-2.69; P = 0.30]) was not significant. On multivariate analysis, MELD, CFF and venous ammonia were predictive of MHE.

CONCLUSION

Prevalence of MHE in this study was 41%; and MELD > 15.5, CFF < 39 Hz and venous ammonia > 84.5 micromol/L were predictive of MHE.

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  • Authors+Show Affiliations

    ,

    Department of Gastroenterology, G. B. Pant Hospital, New Delhi, India.

    Source

    MeSH

    Adult
    Event-Related Potentials, P300
    Female
    Flicker Fusion
    Hepatic Encephalopathy
    Humans
    Liver Cirrhosis
    Logistic Models
    Male
    Neuropsychological Tests
    Predictive Value of Tests
    Prevalence
    Prospective Studies
    Psychometrics
    ROC Curve
    Sensitivity and Specificity
    Statistics, Nonparametric

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    20616413

    Citation

    Sharma, Praveen, and Barjesh C. Sharma. "Predictors of Minimal Hepatic Encephalopathy in Patients With Cirrhosis." Saudi Journal of Gastroenterology : Official Journal of the Saudi Gastroenterology Association, vol. 16, no. 3, 2010, pp. 181-7.
    Sharma P, Sharma BC. Predictors of minimal hepatic encephalopathy in patients with cirrhosis. Saudi J Gastroenterol. 2010;16(3):181-7.
    Sharma, P., & Sharma, B. C. (2010). Predictors of minimal hepatic encephalopathy in patients with cirrhosis. Saudi Journal of Gastroenterology : Official Journal of the Saudi Gastroenterology Association, 16(3), pp. 181-7. doi:10.4103/1319-3767.65189.
    Sharma P, Sharma BC. Predictors of Minimal Hepatic Encephalopathy in Patients With Cirrhosis. Saudi J Gastroenterol. 2010;16(3):181-7. PubMed PMID: 20616413.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Predictors of minimal hepatic encephalopathy in patients with cirrhosis. AU - Sharma,Praveen, AU - Sharma,Barjesh C, PY - 2010/7/10/entrez PY - 2010/7/10/pubmed PY - 2010/11/3/medline SP - 181 EP - 7 JF - Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association JO - Saudi J Gastroenterol VL - 16 IS - 3 N2 - BACKGROUND/AIM: Minimal hepatic encephalopathy (MHE) impairs patient's daily functioning of life. Predictors of MHE in cirrhotic patients have not been evaluated. PATIENTS AND METHODS: A total of 200 cirrhotic patients (Child A, 74 [37%]; Child B, 72 [36%]; Child C, 54 [27%]) were evaluated by psychometry, P300 auditory event-related potential (P300ERP) and critical flicker frequency (CFF). MHE was diagnosed by abnormal psychometry (>2 S.D.) and P300ERP (>2.5 S.D.). Univariate and multivariate logistic regression analyses were performed to determine the predictors of MHE. RESULTS: Eighty-two (41%) patients were diagnosed to have MHE - 26/74 (35%) in Child A, 26/72 (36%) in Child B and 30/54 (56%) in Child C. Ninety-seven (48.5%) patients had abnormal psychometric tests, and 96 (48%) had prolonged P300ERP (>358 ms). Sixteen (16.5%) patients with abnormal psychometry had P300ERP < 358 ms, and 15 (14.5%) patients with normal psychometry results had P300ERP > 358 ms. One hundred and three patients had CFF value < 39 Hz with specificity of 86.6% and sensitivity of 72.9% for MHE. Model for end-stage liver disease (MELD) (17.9 +/- 5.7 vs. 13.4 +/- 4.2, P = 0.005), Child-Turcotte-Pugh (CTP) score (8.4 +/- 2.5 vs. 7.7 +/- 2.2, P = 0.02), ammonia (104.8 +/- 37.9 vs. 72.5 +/- 45.2 micromol/L, P = 0.001) and CFF (37.0 +/- 2.8 vs. 41.0 +/- 3.4 Hz, P = 0.001) were significantly higher in MHE as compared to non-MHE patients. Ninety-one (45.5%) patients had MELD > 15.5, 115 (57.5%) had CTP score > 7.5, while 93 (46.5%) had venous ammonia > 84.5 micromol/L. On univariate analysis, MELD (8.52 [95% CI, 4.46-16.26; P = 0.001]), CFF (17.34 [95% CI, 8.16-36.85; P = 0.001]) and venous ammonia (7.80 [95% CI, 4.11-14.81; P = 0.003]) were associated with MHE; while CTP score (1.51 [95% CI, 0.85-2.69; P = 0.30]) was not significant. On multivariate analysis, MELD, CFF and venous ammonia were predictive of MHE. CONCLUSION: Prevalence of MHE in this study was 41%; and MELD > 15.5, CFF < 39 Hz and venous ammonia > 84.5 micromol/L were predictive of MHE. SN - 1998-4049 UR - https://www.unboundmedicine.com/medline/citation/20616413/Predictors_of_minimal_hepatic_encephalopathy_in_patients_with_cirrhosis_ L2 - http://www.saudijgastro.com/article.asp?issn=1319-3767;year=2010;volume=16;issue=3;spage=181;epage=187;aulast=Sharma DB - PRIME DP - Unbound Medicine ER -