Development and Validation of a Prognostic Score to Predict Covert Hepatic Encephalopathy in Patients With Cirrhosis.

Authors:
Christian Labenz
Christian Labenz
University Medical Center of the Johannes Gutenberg-University
Gerrit Toenges
Gerrit Toenges
Institute of Medical Biostatistics
Madison | United States
Yvonne Huber
Yvonne Huber
Kinderspital Zürich
Michael Nagel
Michael Nagel
RWTH Aachen University
Germany
Jens U Marquardt
Jens U Marquardt
National Cancer Institute
United States
Peter R Galle
Peter R Galle
Johannes Gutenberg University
Germany
Joachim Labenz
Joachim Labenz
Charité University Medical Center
Germany

Am J Gastroenterol 2019 May;114(5):764-770

Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.

Objectives: Diagnosis of covert hepatic encephalopathy (CHE) is challenging and often neglected in clinical practice. The aim of this study was to develop an easy-to-perform score to predict CHE in patients with cirrhosis.

Methods: For the development or validation cohort of the proposed clinical CHE score, 142 or 96 consecutive patients with cirrhosis were prospectively enrolled. The Psychometric Hepatic Encephalopathy Score was used to detect minimal hepatic encephalopathy. All patients were examined with the simplified animal naming test and were asked to complete the Chronic Liver Disease Questionnaire. We followed the TRIPOD guideline for development, validation, and reporting of the proposed score.

Results: The clinical covert hepatic encephalopathy score containing the variables-clinically detectable ascites, history of overt hepatic encephalopathy (OHE), albumin serum level, activity subdomain of the Chronic Liver Disease Questionnaire, and simplified animal naming test-discriminated best between patients with and without CHE. We generated 2 cutoff values for the identification of the high-, intermediate- (with need for additional specialized testing), and low-risk groups for CHE. By applying these cutoffs, the sensitivity, specificity, positive predictive value, and negative predictive value were 90%, 91%, 85%, and 94%, respectively. The AUC was 0.908 or 0.872 for the development or the validation cohort, respectively. Higher scores were further associated with poorer quality of life, and the high-risk group was predictive for first-time OHE within 180 days.

Conclusions: We developed an easy-to-perform score to identify patients with cirrhosis at risk of CHE, which correlates with quality of life and risk of first-time OHE.

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Source
http://dx.doi.org/10.14309/ajg.0000000000000121DOI Listing
May 2019
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