Burak Özbaş1, Onur Keskin2, Hartmut Hecker3, Irfan Karahan1, Cansu Özbaş4, Çağdaş Kalkan2, Aysun Kartal2, Fatih Oğuz Önder1, Burcu Kahveci Öncü5, Genco Gençdal6, Murat Akyildiz6, Fulya Günşar7, Ramazan Idilman2, Karin Weissenborn8, Ömer Özütemiz7, Cihan Yurdaydin9,10. 1. Department of Internal Medicine, Ankara University Medical School, Ankara, Turkey. 2. Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey. 3. Department of Biometrics, Hannover Medical School, Hannover, Germany. 4. Department of Public Health, Gazi University Medical School, Ankara, Turkey. 5. Department of Psychiatry, Ankara University Medical School, Ankara, Turkey. 6. Department of Gastroenterology and Hepatology, Koç University Medical School, Istanbul, Turkey. 7. Department of Gastroenterology, Ege University Medical School, Izmir, Turkey. 8. Department of Neurology, Hannover Medical School, Hannover, Germany. 9. Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey. cyurdaydin@ku.edu.tr. 10. Department of Gastroenterology and Hepatology, Koç University Medical School, Istanbul, Turkey. cyurdaydin@ku.edu.tr.
Abstract
BACKGROUND: Psychometric hepatic encephalopathy score (PHES) needs local standardization. AIMS: This study aimed at standardizing PHES for Turkish patients and compare them with German norms; to determine minimal hepatic encephalopathy (mHE) prevalence with two different methods [PHES battery and Critical Flicker Frequency (CFF)] and to assess whether sub-tests of the battery can be used for screening for mHE. METHODS: Healthy volunteers (n = 816; 400 male) and cirrhotics (n = 124; 58 male) were included. For mHE diagnosis PHES score threshold was set at ≤ - 5 points and that of CFF at < 39 Hz. For comparing German and Turkish norms, datasets were combined. Multiple backward procedure was applied to assess effects of age, sex and education on single tests of the battery. Receiver operating characteristic (ROC) curves were created for assessing diagnostic capabilities of subtests of the battery. RESULTS: PHES norms for Turks were developed. MHE prevalence in compensated cirrhotics was 29.8% and 27.4% with PHES and CFF tests, respectively, with low compatibility (kappa coefficient 0.389); mHE prevalence decreased to 16% when both tests were combined. Turks performed worse vs Germans in the digit symbol (DS) and serial dotting (SD) subtests but performed better in other subtests. In ROC analyzes of subtests, the combination of DS + SD tests achieved an AUROC of 0.974 versus PHES. CONCLUSIONS: Use of two methods for diagnosing mHE is important for research purposes. From a clinical perspective, sensitivity with acceptable specificity may suffice for screening instruments for mHE. Combined use of DS and SD subtests of the PHES battery appears suitable for this purpose.
BACKGROUND: Psychometric hepatic encephalopathy score (PHES) needs local standardization. AIMS: This study aimed at standardizing PHES for Turkish patients and compare them with German norms; to determine minimal hepatic encephalopathy (mHE) prevalence with two different methods [PHES battery and Critical Flicker Frequency (CFF)] and to assess whether sub-tests of the battery can be used for screening for mHE. METHODS: Healthy volunteers (n = 816; 400 male) and cirrhotics (n = 124; 58 male) were included. For mHE diagnosis PHES score threshold was set at ≤ - 5 points and that of CFF at < 39 Hz. For comparing German and Turkish norms, datasets were combined. Multiple backward procedure was applied to assess effects of age, sex and education on single tests of the battery. Receiver operating characteristic (ROC) curves were created for assessing diagnostic capabilities of subtests of the battery. RESULTS: PHES norms for Turks were developed. MHE prevalence in compensated cirrhotics was 29.8% and 27.4% with PHES and CFF tests, respectively, with low compatibility (kappa coefficient 0.389); mHE prevalence decreased to 16% when both tests were combined. Turks performed worse vs Germans in the digit symbol (DS) and serial dotting (SD) subtests but performed better in other subtests. In ROC analyzes of subtests, the combination of DS + SD tests achieved an AUROC of 0.974 versus PHES. CONCLUSIONS: Use of two methods for diagnosing mHE is important for research purposes. From a clinical perspective, sensitivity with acceptable specificity may suffice for screening instruments for mHE. Combined use of DS and SD subtests of the PHES battery appears suitable for this purpose.
Authors: Hendrik Vilstrup; Piero Amodio; Jasmohan Bajaj; Juan Cordoba; Peter Ferenci; Kevin D Mullen; Karin Weissenborn; Philip Wong Journal: Hepatology Date: 2014-07-08 Impact factor: 17.425
Authors: Jasmohan S Bajaj; Ashwin N Ananthakrishnan; Emily L McGinley; Raymond G Hoffmann; Karen J Brasel Journal: Am J Gastroenterol Date: 2008-07-04 Impact factor: 10.864
Authors: Marsha Y Morgan; Piero Amodio; Nicola A Cook; Clive D Jackson; Gerald Kircheis; Mette M Lauridsen; Sara Montagnese; Sami Schiff; Karin Weissenborn Journal: Metab Brain Dis Date: 2015-09-28 Impact factor: 3.584
Authors: M Groeneweg; J C Quero; I De Bruijn; I J Hartmann; M L Essink-bot; W C Hop; S W Schalm Journal: Hepatology Date: 1998-07 Impact factor: 17.425