Covert hepatic encephalopathy: agreement and predictive validity of different indices

Sara Montagnese; Esmeralda Balistreri; Sami Schiff; Michele De Rui; Paolo Angeli; Giacomo Zanus; Umberto Cillo; Giancarlo Bombonato; Massimo Bolognesi; David Sacerdoti; Angelo Gatta; Carlo Merkel; Piero Amodio

doi:10.3748/wjg.v20.i42.15756

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Covert hepatic encephalopathy: agreement and predictive validity of different indices

Journal article

Peer reviewed

Covert hepatic encephalopathy: agreement and predictive validity of different indices

Sara Montagnese, Esmeralda Balistreri, Sami Schiff, Michele De Rui, Paolo Angeli, Giacomo Zanus, Umberto Cillo, Giancarlo Bombonato, Massimo Bolognesi, David Sacerdoti, …

World journal of gastroenterology : WJG, Vol.20(42), pp.15756-15762

14/11/2014

DOI: https://doi.org/10.3748/wjg.v20.i42.15756

PMCID: PMC4229541

PMID: 25400460

Abstract

Aged

Asymptomatic Diseases

Female

Hepatic Encephalopathy - diagnosis

Hepatic Encephalopathy - etiology

Hepatic Encephalopathy - mortality

Hepatic Encephalopathy - physiopathology

Hepatic Encephalopathy - psychology

Hepatic Encephalopathy - therapy

Hospitalization

Humans

Kaplan-Meier Estimate

Liver Cirrhosis - complications

Liver Cirrhosis - diagnosis

Liver Cirrhosis - mortality

Liver Cirrhosis - therapy

Male

Middle Aged

Neuropsychological Tests

Observer Variation

Predictive Value of Tests

Prognosis

Psychometrics

Reproducibility of Results

Risk Factors

Severity of Illness Index

Time Factors

Ultrasonography, Doppler

Electroencephalography

To investigate the agreement and prognostic value of different measures of covert hepatic encephalopathy (CHE). 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 hepatic encephalopathy (HE)-related hospitalisations. 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. CHE diagnosis probably requires a combination of clinical, neurophysiological and neuropsychological indices.

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Title: Covert hepatic encephalopathy: agreement and predictive validity of different indices
Creators: Sara Montagnese - Sara Montagnese, Esmeralda Balistreri, Sami Schiff, Michele De Rui, Paolo Angeli, Giancarlo Bombonato, Massimo Bolognesi, David Sacerdoti, Angelo Gatta, Carlo Merkel, Piero Amodio, Department of Medicine, University of Padova, 35128 Padova, Italy.
Esmeralda Balistreri - Sara Montagnese, Esmeralda Balistreri, Sami Schiff, Michele De Rui, Paolo Angeli, Giancarlo Bombonato, Massimo Bolognesi, David Sacerdoti, Angelo Gatta, Carlo Merkel, Piero Amodio, Department of Medicine, University of Padova, 35128 Padova, Italy.
Sami Schiff - Sara Montagnese, Esmeralda Balistreri, Sami Schiff, Michele De Rui, Paolo Angeli, Giancarlo Bombonato, Massimo Bolognesi, David Sacerdoti, Angelo Gatta, Carlo Merkel, Piero Amodio, Department of Medicine, University of Padova, 35128 Padova, Italy.
Michele De Rui - Sara Montagnese, Esmeralda Balistreri, Sami Schiff, Michele De Rui, Paolo Angeli, Giancarlo Bombonato, Massimo Bolognesi, David Sacerdoti, Angelo Gatta, Carlo Merkel, Piero Amodio, Department of Medicine, University of Padova, 35128 Padova, Italy.
Paolo Angeli - Sara Montagnese, Esmeralda Balistreri, Sami Schiff, Michele De Rui, Paolo Angeli, Giancarlo Bombonato, Massimo Bolognesi, David Sacerdoti, Angelo Gatta, Carlo Merkel, Piero Amodio, Department of Medicine, University of Padova, 35128 Padova, Italy.
Giacomo Zanus - Sara Montagnese, Esmeralda Balistreri, Sami Schiff, Michele De Rui, Paolo Angeli, Giancarlo Bombonato, Massimo Bolognesi, David Sacerdoti, Angelo Gatta, Carlo Merkel, Piero Amodio, Department of Medicine, University of Padova, 35128 Padova, Italy.
Umberto Cillo - Sara Montagnese, Esmeralda Balistreri, Sami Schiff, Michele De Rui, Paolo Angeli, Giancarlo Bombonato, Massimo Bolognesi, David Sacerdoti, Angelo Gatta, Carlo Merkel, Piero Amodio, Department of Medicine, University of Padova, 35128 Padova, Italy.
Giancarlo Bombonato - Sara Montagnese, Esmeralda Balistreri, Sami Schiff, Michele De Rui, Paolo Angeli, Giancarlo Bombonato, Massimo Bolognesi, David Sacerdoti, Angelo Gatta, Carlo Merkel, Piero Amodio, Department of Medicine, University of Padova, 35128 Padova, Italy.
Massimo Bolognesi - Sara Montagnese, Esmeralda Balistreri, Sami Schiff, Michele De Rui, Paolo Angeli, Giancarlo Bombonato, Massimo Bolognesi, David Sacerdoti, Angelo Gatta, Carlo Merkel, Piero Amodio, Department of Medicine, University of Padova, 35128 Padova, Italy.
David Sacerdoti - Sara Montagnese, Esmeralda Balistreri, Sami Schiff, Michele De Rui, Paolo Angeli, Giancarlo Bombonato, Massimo Bolognesi, David Sacerdoti, Angelo Gatta, Carlo Merkel, Piero Amodio, Department of Medicine, University of Padova, 35128 Padova, Italy.
Angelo Gatta - Sara Montagnese, Esmeralda Balistreri, Sami Schiff, Michele De Rui, Paolo Angeli, Giancarlo Bombonato, Massimo Bolognesi, David Sacerdoti, Angelo Gatta, Carlo Merkel, Piero Amodio, Department of Medicine, University of Padova, 35128 Padova, Italy.
Carlo Merkel - Sara Montagnese, Esmeralda Balistreri, Sami Schiff, Michele De Rui, Paolo Angeli, Giancarlo Bombonato, Massimo Bolognesi, David Sacerdoti, Angelo Gatta, Carlo Merkel, Piero Amodio, Department of Medicine, University of Padova, 35128 Padova, Italy.
Piero Amodio - Sara Montagnese, Esmeralda Balistreri, Sami Schiff, Michele De Rui, Paolo Angeli, Giancarlo Bombonato, Massimo Bolognesi, David Sacerdoti, Angelo Gatta, Carlo Merkel, Piero Amodio, Department of Medicine, University of Padova, 35128 Padova, Italy.
Publication Details: World journal of gastroenterology : WJG, Vol.20(42), pp.15756-15762
Date published: 14/11/2014
Identifiers: 99699260202346
Academic Unit: School of Biosciences
Language: English
Resource Type: Journal article

Covert hepatic encephalopathy: agreement and predictive validity of different indices

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