Prospective comparative study of inhibitory control test and psychometric hepatic encephalopathy score for diagnosis and prognosis of minimal hepatic encephalopathy in cirrhotic patients in the <scp>I</scp>ndian subcontinent

Gupta, Dhaval; Ingle, Meghraj; Shah, K. L.; Phadke, Aniruddha; Sawant, Prabha

doi:10.1111/1751-2980.12248

Cited by 28 publications

(45 citation statements)

References 25 publications

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“…In the current study, the PHES and ICT did not correlate with the severity of liver disease, as measured by CTP score and MELD score. This observation matches results in the previous work done by Taneja et al 23 but opposed the findings of Gupta et al 22 who found correlation between ICT and severity of liver disease.…”

Section: Discussionsupporting

confidence: 89%

“…The sensitivity of 78.87% and specificity of 66.06% with area under the curve of 0.724 (95% CI: 0.653-0.788) indicates that, in Indian patients, ICT has a much lower sensitivity, specificity, and area under the curve for MHE diagnosis. In one of the previous Indian studies, sensitivity, specificity and receiver operating characteristic of the ICT were 92.6%, 78.5% and 0.855 respectively, 22 while in another study they were 78%, 65.6% and 0.735 respectively for the diagnosis of MHE in liver cirrhosis. 23 For the diagnosis of MHE, the PHES is considered to be a reliable tool.…”

Section: Discussionmentioning

confidence: 83%

“…Since the lure threshold needs to be adjusted according to the local population norms, we took the lure threshold of $14 as the diagnostic cut off for diagnosis of HE. 22,23 In our study, we considered only lures and not weighted lures as suggested by Amodio et al (unpublished study).…”

Section: Study Protocolmentioning

confidence: 99%

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Minimal Hepatic Encephalopathy in Indians: Psychometric Hepatic Encephalopathy Score and Inhibitory Control Test for Diagnosis and Rifaximin or Lactulose for Its Reversal

Pawar

Surude

Sonthalia

et al. 2019

Journal of Clinical and Translational Hepatology

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Background and Aims: Psychometric hepatic encephalopathy score (PHES) is used widely for diagnosis of minimal hepatic encephalopathy (MHE). This prospective study aimed to determine the utility of the inhibitory control test (ICT) for the diagnosis of MHE. Additionally, the efficacy of rifaximin and lactulose for reversal of MHE was evaluated. Methods: A total of 180 eligible cirrhotic patients underwent testing for MHE. When PHES was # −5 and ICT lures were $ 14, MHE was diagnosed. The 108 patients with MHE were randomized to three groups for treatment with either lactulose, rifaximin, or placebo. Treatment outcomes were measured at the end of 3 months. Results: The 108 patients with MHE diagnosed by PHES and/or ICT accounted for 60%. The diagnosis of MHE was made by both ICT and PHES positivity in 56 patients, by abnormal ICT and normal PHES in 37 patients, and by abnormal PHES and normal ICT in 15 patients. For diagnosis of MHE, ICT had sensitivity of 78.87%, specificity of 66.06% with 60.22% positive predictive value and 82.76% negative predictive value. An area under the curve value of 0.724 (95% CI: 0.653-0.788) was obtained for diagnosis of MHE. Reversal of MHE was seen in 71.42%, 70.27% and 11.11% of patients in the rifaximin, lactulose and placebo arms (p < 0.001). Rifaximin showed better tolerability compared to lactulose. Conclusions: For the diagnosis of MHE, ICT is a simple tool but has lower sensitivity and better specificity than PHES. Rifaximin is as efficacious as lactulose in the treatment of MHE and better tolerated.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 83%

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Minimal Hepatic Encephalopathy in Indians: Psychometric Hepatic Encephalopathy Score and Inhibitory Control Test for Diagnosis and Rifaximin or Lactulose for Its Reversal

Pawar

Surude

Sonthalia

et al. 2019

Journal of Clinical and Translational Hepatology

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“…In this study, only four subjects had OHE history, which would make the results difficult to interpret for the larger OHE Chinese population. Lastly, learning effects were observed in performing PHES . As a single‐visit study, we cannot draw conclusions on whether a learning effect will influence the result of EncephalApp Stroop Test.…”

Section: Discussionmentioning

confidence: 89%

Utility of the EncephalApp Stroop Test for covert hepatic encephalopathy screening in Chinese cirrhotic patients

Zeng

Shi

et al. 2019

J of Gastro and Hepatol

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Background and Aim Considering the large size of the potential population and limitations of common detection methods, covert hepatic encephalopathy (CHE) is difficult to screen for routinely. The present study aims to explore EncephalApp Stroop Test as a smartphone‐based CHE screening tool in China. Methods A multicenter, single‐visit study was carried out. The cutoff of the Chinese EncephalApp translation was determined by using Chinese standardized psychometric hepatic encephalopathy score (PHES) in cirrhotic patients as the gold standard. Indicators reflecting time required and number of tests on subtask on (naming the color of pound signs) and off (naming the color of the word in discordant coloring) were recorded, with the feedback from investigators and patients. Results One hundred forty‐four patients were included; 58 (40.28%) patients were diagnosed with CHE by PHES. The cutoff of > 97.34 s for off time and > 186.63 s for on time + off time had the maximum area under the curve values (0.77) in all patients. Furthermore, with the cutoff of 186.63 s, on time + off time has the highest sensitivity (0.86). However, the specificity was unsatisfactory (0.59). Age and alcoholic hepatitis (odds ratio = 1.05 and 3.12, both P < 0.05) were positively correlated with the risk of CHE. The experience with electronic devices and education duration were negatively correlated (odds ratio = 0.21 and 0.92, both P < 0.05). Compared with PHES, EncephalApp represented 38% time saving. Furthermore, it was superior to PHES regarding accessibility, convenience, and acceptability by administrators (all P < 0.05). Conclusions The EncephalApp Stroop Test is an efficient screening tool for CHE in Chinese cirrhotic patients.

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“…The ICT is another test for diagnosis of MHE, and various studies have shown it to be important for prediction of overt HE. 16 The International Society for Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN) recommends that two different tests should be used to diagnose MHE, which includes one of the tests, which is widely accepted to serve as the comparator. 17 The upcoming modalities for diagnosis of cognitive dysfunction in cirrhosis are biomarkers and newer imaging tools.…”

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confidence: 99%

Managing encephalopathy in the outpatient setting

Rathi

Dhiman

2016

Clinical Liver Disease

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In cirrhosis of liver, hepatic encephalopathy (HE) has an important impact on health-related quality of life. It is important to define whether HE is episodic, recurrent, or persistent; types A, B, or C; overt HE or covert HE; and spontaneous or precipitated. The overt HE is clinically evident and needs hospitalization. Nonabsorbable disaccharides, rifaximin, and probiotics are proven to be useful in the treatment of overt HE. Covert HE includes both minimal HE and grade I HE. It is not apparent on routine clinical examination. Presence of poor work productivity, increased accidental injuries on complex machinery and driving, etc., raise the suspicion of cognitive dysfunction. Specialized neurocognitive testing like psychometric HE, computerized tests like critical flicker frequency tests, inhibitory control tests, Stroop encephalopathy tests, and electroencephalography are needed to diagnose overt HE. Various studies have shown lactulose and rifaximin to be useful in overt HE. However, presence of persistent and recurrent HE in cirrhosis is an indication for liver transplant. Lactulose is effective both in improving reversal of minimal HE and in reducing the risk of development of overt HE.

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Prospective comparative study of inhibitory control test and psychometric hepatic encephalopathy score for diagnosis and prognosis of minimal hepatic encephalopathy in cirrhotic patients in the Indian subcontinent

Abstract: ICT is useful for diagnosing MHE in patients with cirrhosis. It is correlated with disease severity and predicts the development of OHE and probable survival with excellent test-retest reliability.

Cited by 28 publications

References 25 publications

Minimal Hepatic Encephalopathy in Indians: Psychometric Hepatic Encephalopathy Score and Inhibitory Control Test for Diagnosis and Rifaximin or Lactulose for Its Reversal

Minimal Hepatic Encephalopathy in Indians: Psychometric Hepatic Encephalopathy Score and Inhibitory Control Test for Diagnosis and Rifaximin or Lactulose for Its Reversal

Utility of the EncephalApp Stroop Test for covert hepatic encephalopathy screening in Chinese cirrhotic patients

Managing encephalopathy in the outpatient setting

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