Prognostic Benefit of the Addition of a Quantitative Index of Hepatic Encephalopathy to the MELD score: the MELD‐EEG

Montagnese, Sara; Rui, Michele De; Schiff, Sami; Ceranto, Elena; Valenti, Pietro; Angeli, Paolo; Cillo, Umberto; Zanus, Giacomo; Gatta, Angelo; Amodio, Piero; Merkel, Carlo

doi:10.1111/liv.12490

Cited by 38 publications

(38 citation statements)

References 29 publications

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“…Although it is well known that one episode of OHE begets another (22,23), it is still unclear whether specific factors can predict the first OHE episode from a neurocognitive basis. This is because several previous studies of CHE and ultimate OHE development included subgroups that were being treated for OHE, often included the Child score (which has OHE in it) for prognostication, or were carried out in centers that did not offer transplant (9–12), Our study, however, extends the literature by rigorously excluding patients with previous overt HE who are usually not considered a high risk as they are perceived as being “stable” and form the majority of the clinical practice in cirrhosis clinics. Therefore, neither these patients nor their caregivers routinely receive education about what to expect or how to react if and when the patients develop their first OHE episode.…”

Section: Discussionmentioning

confidence: 99%

“…However, the prognostic significance of CHE, especially in patients who have never experienced a previous OHE episode, is not fully understood. Previous studies that show a worse prognosis for CHE patients have typically included those with previous OHE who are clearly at a higher risk for recurrence or have used the Child–Turcotte–Pugh score that includes OHE as a scoring tool or have been performed in centers where liver transplants are not offered (9–13). Therefore, this lack of clarity regarding prognostication of CHE patients without previous OHE could be one of the reasons why CHE testing is not routinely performed beyond research studies, especially in the United States.…”

Section: Introductionmentioning

confidence: 99%

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Covert Hepatic Encephalopathy Is Independently Associated With Poor Survival and Increased Risk of Hospitalization

Patidar

Thacker

Wade

et al. 2014

American Journal of Gastroenterology

163

119

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OBJECTIVES Despite the high prevalence of covert hepatic encephalopathy (CHE) in cirrhotics without previous overt HE (OHE), its independent impact on predicting clinically relevant outcomes is unclear. The aim of this study was to define the impact of CHE on time to OHE, hospitalization, and death/transplant in prospectively followed up patients without previous OHE. METHODS Outpatient cirrhotics without OHE were enrolled and were administered a standard paper–pencil cognitive battery for CHE diagnosis. They were systematically followed up and time to first OHE development, hospitalization (liver-related/unrelated), and transplant/death were compared between CHE and no-CHE patients at baseline using Cox regression. RESULTS A total of 170 cirrhotic patients (55 years, 58% men, 14 years of education, Model for End-Stage Liver Disease (MELD 9), 53% hepatitis C virus (HCV), 20% nonalcoholic etiology) were included, of whom 56% had CHE. The entire population was followed up for 13.0±14.6 months, during which time 30% developed their first OHE episode, 42% were hospitalized, and 19% had a composite death/transplant outcome. Age, gender, etiology, the MELD score, and CHE status were included in Cox regression models for time to first OHE episode, hospitalization, death, and composite death/transplant outcomes. On Cox regression, despite controlling for MELD, those with CHE had a higher risk of developing OHE (hazard ratio: 2.1, 95% confidence interval 1.01–4.5), hospitalization (hazard ratio: 2.5, 95% confidence interval 1.4–4.5), and death/transplant (hazard ratio: 3.4, 95% confidence interval 1.2–9.7) in the follow-up period. CONCLUSIONS Covert HE is associated with worsened survival and increased risk of hospitalization and OHE development, despite controlling for the MELD score. Strategies to detect and treat CHE may improve these risks.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Covert Hepatic Encephalopathy Is Independently Associated With Poor Survival and Increased Risk of Hospitalization

Patidar

Thacker

Wade

et al. 2014

American Journal of Gastroenterology

163

119

View full text Add to dashboard Cite

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“…The value of such approach was recently confirmed 26 and a large, validated observational study proved that the use of the MDF of the EEG improves the predictive value of the MELD score. 14,27 In well compensated cirrhotic patients the prognostic value of minor EEG changes might be lower than in patients with advanced liver disease. 14,28 In fact, the attribution to HE of any change of brain functional, as well as of cognition, in these patients might be questionable (i.e., it may have low positive predictive value), because the 'a priori' probability of HE is low.…”

Section: Quantitative Eegmentioning

confidence: 99%

Clinical Neurophysiology of Hepatic Encephalopathy

Amodio

Montagnese

2015

Journal of Clinical and Experimental Hepatology

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Background/Objectives: Hepatic encephalopathy (HE) has relevant impact on the quality of life of patients and their caregivers and causes relevant costs because of hospitalizations and work days lost. Its quantification is important to perform adequate clinical trials on this relevant complication of cirrhosis and portal-systemic shunting. Clinical neurophysiology, which detects functional alterations of the nervous system, has been applied to the study of HE for over 60 years. This review aims at summarizing and clarifying the role of neurophysiologic techniques in the study of HE. Methods: A narrative review was performed aiming at interpreting the cited papers and the techniques on the basis of their physiological and pathophysiological meaning. Results: The potential role of EEG, quantified EEG, evoked potentials-both exogenous, endogenous and motor-have been clarified to the reader that may be unfamiliar with neurophysiology. Conclusions: The EEG, reflecting the oscillatory changes of neural network is the preferable tool to detect and monitor HE, with the exception of its most severe stage, when EEG flattens. SSEP and MEP have indication to detect and monitor transmission alterations that are likely related to myelin changes and microedema. ( J CLIN EXP HEPATOL 2014;5:S60-S68)

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“…The results prove the fact that HE patients are correlated with abnormal EEG and their basic rhythms gradually become slow. [15][16][17] Furthermore, our Brain-Health system achieved the high accuracy of about 91.79% and 93.89% corresponding to the classification of Group 1-Group 2 and Group 1-Group 3 based on SVM. In conclusion, the good performance and high accuracy indicated the feasibility and effectiveness of our Brain-Health system for encephalopathy daily monitoring, health self-management, and clinical medical research.…”

Section: Introductionmentioning

confidence: 99%

A real-time wireless wearable electroencephalography system based on Support Vector Machine for encephalopathy daily monitoring

Zhang

Wang

Liu

et al. 2018

International Journal of Distributed Sensor Networks

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Wearable electroencephalography systems of out-of-hospital can both provide complementary recordings and offer several benefits over long-term monitoring. However, several limitations were present in these new-born systems, for example, uncomfortable for wearing, inconvenient for retrieving the recordings by patients themselves, unable to timely provide accurate classification, and early warning information. Therefore, we proposed a wireless wearable electroencephalography system for encephalopathy daily monitoring, named as Brain-Health, which focused on the following three points: (a) the monitoring device integrated with electroencephalography acquisition sensors, signal processing chip, and Bluetooth, attached to a sport hat or elastic headband; (b) the mobile terminal with dedicated application, which is not only for continuous recording and displaying electroencephalography signal but also for early warning in real time; and (c) the encephalopathy's classification algorithm based on intelligent Support Vector Machine, which is used in a new application of wearable electroencephalography for encephalopathy daily monitoring. The results showed a high mean accuracy of 91.79% and 93.89% in two types of classification for encephalopathy. In conclusion, good performance of our Brain-Health system indicated the feasibility and effectiveness for encephalopathy daily monitoring and patients' health self-management.

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Prognostic Benefit of the Addition of a Quantitative Index of Hepatic Encephalopathy to the MELD score: the MELD‐EEG

Abstract: The addition of an automatically obtained EEG-based index improves the prognostic accuracy of the MELD score.

Cited by 38 publications

References 29 publications

Covert Hepatic Encephalopathy Is Independently Associated With Poor Survival and Increased Risk of Hospitalization

Covert Hepatic Encephalopathy Is Independently Associated With Poor Survival and Increased Risk of Hospitalization

Clinical Neurophysiology of Hepatic Encephalopathy

A real-time wireless wearable electroencephalography system based on Support Vector Machine for encephalopathy daily monitoring

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