Brief Article
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World J Gastroenterol. Dec 14, 2013; 19(46): 8745-8751
Published online Dec 14, 2013. doi: 10.3748/wjg.v19.i46.8745
Psychometric hepatic encephalopathy score for diagnosis of minimal hepatic encephalopathy in China
Su-Wen Li, Kai Wang, Yong-Qiang Yu, Hai-Bao Wang, Yuan-Hai Li, Jian-Ming Xu
Su-Wen Li, Jian-Ming Xu, Anhui Geriatric Institute of Anhui Medical University, Hefei 230022, Anhui Province, China
Su-Wen Li, Jian-Ming Xu, Department of Gastroenterology, the First Affiliated Hospital, Anhui Medical University, Hefei 230022, Anhui Province, China
Su-Wen Li, Jian-Ming Xu, Key Laboratory of Gastroenterology of Anhui Province, Hefei 230022, Anhui Province, China
Kai Wang, Department of Neurology, the First Affiliated Hospital, Anhui Medical University, Hefei 230022, Anhui Province, China
Yong-Qiang Yu, Hai-Bao Wang, Department of Radiology, the First Affiliated Hospital, Anhui Medical University, Hefei 230022, Anhui Province, China
Yuan-Hai Li, Department of Anaesthesiology, the First Affiliated Hospital, Anhui Medical University, Hefei 230022, Anhui Province, China
Author contributions: Wang K, Yu YQ and Xu JM designed the research; Li SW and Wang HB performed the research; Li SW and Li YH analyzed the data; Li SW wrote the paper; and Xu JM revised the manuscript.
Correspondence to: Jian-Ming Xu, MD, PhD, Professor, Department of Gastroenterology, the First Affiliated Hospital, Anhui Medical University, Hefei 230022, Anhui Province, China. xujm1017@163.com
Telephone: +86-551-62922039 Fax: +86-551-63633742
Received: September 10, 2013
Revised: October 20, 2013
Accepted: November 1, 2013
Published online: December 14, 2013
Processing time: 98 Days and 14 Hours
Abstract

AIM: To construct normal values for the tests of the psychometric hepatic encephalopathy score (PHES) and to evaluate its usefulness in the diagnosis of minimal hepatic encephalopathy (MHE) among Chinese individuals with cirrhosis.

METHODS: The five tests of PHES, number connection test-A (NCT-A), number connection test-B, serial dotting test, line tracing test and digit symbol test (DST), were administered to all enrolled subjects in a quiet room with sufficient light. Cirrhotic subjects with overt HE were excluded by the West-Haven criteria and a detailed neurological examination. Based on the nomograms of healthy volunteers, the patients were classified as having MHE when their PHES was less than -4.

RESULTS: In total, 146 healthy volunteers completed all the PHES tests. Age and education years were confirmed to be predictors of all five tests. In total, 53 patients with liver cirrhosis completed the PHES. Of the patients with liver cirrhosis, 24 (45.3%), 22(41.5%) and 7(13.2%) had Child-Pugh grades A, B and C, respectively. MHE was diagnosed in 26 patients (49.1%). Compared with compensated cirrhotic patients (Child A), decompensated cirrhotic patients (Child B and C) had a higher proportion of MHE (65.5% vs 29.2%). No differences in age and education years were found between the MHE and non-MHE groups. NCT-A and DST were able to diagnose MHE with a sensitivity of 76.9% and a specificity of 96.3% (AUC = 0.866, K = 0.735).

CONCLUSION: The proportion of MHE is associated with liver function. NCT-A and DST are simple tools that can be used for the diagnosis of MHE in China.

Keywords: Cirrhosis; Minimal hepatic encephalopathy; Neuropsychological tests; Psychometric hepatic encephalopathy score; Number connection test; Digit symbol test

Core tip: The psychometric hepatic encephalopathy score (PHES) has been standardized in several countries, but requires further validation in China. The authors aimed to evaluate the usefulness of PHES for the diagnosis of minimal hepatic encephalopathy (MHE) among Chinese patients with liver cirrhosis. In China, the results of the five neuropsychological tests of PHES were influenced by age and educational status. In total, 49.1% of the patients with cirrhosis were classified as having MHE, and the proportion of MHE was associated with the severity of liver function. Number connection test-A and digit symbol test are simple and useful tools that can be used for the diagnosis of MHE in China.