Christian Labenz1,2, Gerrit Toenges3, Yvonne Huber1,2, Michael Nagel1,2, Jens U Marquardt1,2, Jörn M Schattenberg1,2, Peter R Galle1,2, Joachim Labenz4, Marcus-Alexander Wörns1,2. 1. Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany. 2. Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany. 3. Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany. 4. Department of Internal Medicine, Diakonie Klinikum, Jung-Stilling Hospital, Siegen, Germany.
Abstract
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.
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.
Authors: Chathur Acharya; Jawaid Shaw; Nikki Duong; Andrew Fagan; Sara McGeorge; James B Wade; Leroy R Thacker; Jasmohan S Bajaj Journal: Clin Gastroenterol Hepatol Date: 2022-01-06 Impact factor: 13.576
Authors: Christian Labenz; Michael Nagel; Paula Kämper; Sinah Engel; Stefan Bittner; Leonard Kaps; Peter R Galle; Jörn M Schattenberg; Marcus-Alexander Wörns; Felix Lüssi Journal: Clin Transl Gastroenterol Date: 2021-10-19 Impact factor: 4.488
Authors: Christian Labenz; Gerrit Toenges; Jörn M Schattenberg; Michael Nagel; Yvonne Huber; Jens U Marquardt; Joachim Labenz; Peter R Galle; Marcus-Alexander Wörns Journal: Clin Transl Gastroenterol Date: 2020-06 Impact factor: 4.396
Authors: Mette Munk Lauridsen; Peter Jepsen; Charlotte Wilhelmina Wernberg; Ove B Schaffalitzky de Muckadell; Jasmohan S Bajaj; Hendrik Vilstrup Journal: Hepatol Commun Date: 2020-07-03
Authors: Wolfgang M Kremer; Michael Nagel; Michael Reuter; Max Hilscher; Maurice Michel; Leonard Kaps; Joachim Labenz; Peter R Galle; Martin F Sprinzl; Marcus-Alexander Wörns; Christian Labenz Journal: Clin Transl Gastroenterol Date: 2020-07 Impact factor: 4.396