Covert hepatic encephalopathy: agreement and predictive validity of different indices

World J Gastroenterol. 2014 Nov 14;20(42):15756-62. doi: 10.3748/wjg.v20.i42.15756.


Aim: To investigate the agreement and prognostic value of different measures of covert hepatic encephalopathy (CHE).

Methods: One-hundred-and-thirty-two cirrhotic outpatients underwent electroencephalography (EEG), paper-and-pencil psychometry (PHES) and critical flicker frequency, scored on the original/modified (CFFo/CFFm) thresholds. Eighty-four patients underwent Doppler-ultrasound to diagnose/exclude portal-systemic shunt. Seventy-nine were followed-up for 11 ± 7 mo in relation to the occurrence of hepatic encephalopathy (HE)-related hospitalisations.

Results: On the day of study, 36% had grade I HE, 42% abnormal EEG, 33% abnormal PHES and 31/21% abnormal CFFo/CFFm. Significant associations were observed between combinations of test abnormalities; however, agreement was poor (Cohen's κ < 0.4). The prevalence of EEG, PHES and CFFo/CFFm abnormalities was significantly higher in patients with grade I overt HE. The prevalence of EEG and CFFm abnormalities was higher in patients with shunt. The prevalence of EEG abnormalities was significantly higher in patients with a history of HE. During follow-up, 10 patients died, 10 were transplanted and 29 had HE-related hospitalisations. Grade I HE (P = 0.004), abnormal EEG (P = 0.008) and abnormal PHES (P = 0.04) at baseline all predicted the subsequent occurrence of HE; CFF did not.

Conclusion: CHE diagnosis probably requires a combination of clinical, neurophysiological and neuropsychological indices.

Keywords: Ammonia; Electroencephalography; Hepatic encephalopathy; Liver cirrhosis; Psychometry.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Aged
  • Asymptomatic Diseases
  • Electroencephalography*
  • Female
  • Hepatic Encephalopathy / diagnosis*
  • Hepatic Encephalopathy / etiology
  • Hepatic Encephalopathy / mortality
  • Hepatic Encephalopathy / physiopathology
  • Hepatic Encephalopathy / psychology
  • Hepatic Encephalopathy / therapy
  • Hospitalization
  • Humans
  • Kaplan-Meier Estimate
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / diagnosis
  • Liver Cirrhosis / mortality
  • Liver Cirrhosis / therapy
  • Male
  • Middle Aged
  • Neuropsychological Tests*
  • Observer Variation
  • Predictive Value of Tests
  • Prognosis
  • Psychometrics
  • Reproducibility of Results
  • Risk Factors
  • Severity of Illness Index
  • Time Factors
  • Ultrasonography, Doppler