Prediction of overt hepatic encephalopathy by the continuous reaction time method and the portosystemic encephalopathy syndrome test in clinically mentally unimpaired patients with cirrhosis


Autoři: Charlotte W. Wernberg aff001;  Ove B. Schaffalitzky de Muckadell aff002;  Hendrik Vilstrup aff003;  Mette M. Lauridsen aff001
Působiště autorů: Department of Gastroenterology, Hospital of Southwest Jutland, Esbjerg, Region of Southwest of Denmark, Denmark aff001;  Department for Medical Gastrointestinal Diseases, Odense University Hospital, Odense, Region of Southwest of Denmark, Denmark aff002;  Department of Hepatology and Gastroenterology, Aarhus University Hospital, Central Denmark Region, Denmark aff003
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226283

Souhrn

Background and aim

Predicting overt hepatic encephalopathy (OHE) is important because the condition is frequent, often requires hospitalization and is potentially preventable. The risk of OHE is related to pre-existing discrete cognitive defects, and for clinical practice it is recommended to apply two different psychometric tests to detect such deficits. We used the continuous reaction time test (CRT) and the portosystemic encephalopathy (PSE) syndrome test and examined their single and combined value for OHE prediction in cirrhosis patients.

Patients and methods

We studied 130 clinically mentally unimpaired cirrhosis patients by the two tests and followed them for an average of 38.5 months. The CRT measures velocity and stability of motor reaction times to 150 repeated auditory signals. The PSE is a five sub-set paper-and-pencil test battery evaluating cognitive and psychomotor processing, speed and vision-motor coordination. We collected data on episodes of OHE during follow-up. The clinical course was analysed in patient groups according to the outcome of each test and of both tests together. No anti-HE treatment was initiated except for cases with OHE.

Results

At baseline, the CRT test was abnormal in 74 patients and the PSE in 47. During follow-up 35 patients (27%) experienced 74 OHE events. 23 patients with abnormal CRT experienced OHE (prediction sensitivity 65%). The PSE predicted OHE in 14 patients (prediction sensitivity 40%). One or both tests were abnormal in 87/130 (67%) and this predicted OHE in 27 patients (21%) (prediction sensitivity 77%).

Conclusion

The CRT test was clinically useful in identifying two-thirds of clinically mentally unimpaired cirrhosis patients who later experienced OHE, and the use of both the CRT and PSE showed satisfactory prediction by identifying three-fourths of later OHE cases.

Klíčová slova:

Alcohol consumption – Cirrhosis – Cognition – Cognitive impairment – Cognitive psychology – Denmark – Psychometrics – Reaction time


Zdroje

1. Jepsen P, Ott P, Andersen PK, Sorensen HT, Vilstrup H. Clinical course of alcoholic liver cirrhosis: a Danish population-based cohort study. Hepatology. 2010;51(5):1675–82. doi: 10.1002/hep.23500 20186844.

2. Jepsen P, Vilstrup H, Andersen PK. The clinical course of cirrhosis: The importance of multistate models and competing risks analysis. Hepatology. 2015;62(1):292–302. doi: 10.1002/hep.27598 25376655.

3. Córdoba J. New assessment of hepatic encephalopathy. Journal of Hepatology. 2011;54(5):1030–40. doi: 10.1016/j.jhep.2010.11.015 21145874

4. Flud CR, Duarte-Rojo A. Prognostic Implications of Minimal/Covert Hepatic Encephalopathy: Large-scale Validation Cohort Studies. J Clin Exp Hepatol. 2019;9(1):112–6. Epub 2019/02/16. doi: 10.1016/j.jceh.2018.04.009 30765944; PubMed Central PMCID: PMC6363948.

5. Bossen L, Gines P, Vilstrup H, Watson H, Jepsen P. Serum sodium as a risk factor for hepatic encephalopathy in patients with cirrhosis and ascites. J Gastroenterol Hepatol. 2019;34(5):914–20. Epub 2018/12/01. doi: 10.1111/jgh.14558 30500090.

6. Watson H, Guevara M, Vilstrup H, Gines P. Improvement of hyponatremia in cirrhosis is associated with improved complex information processing. J Gastroenterol Hepatol. 2019. Epub 2019/04/10. doi: 10.1111/jgh.14683 30965392.

7. Greinert R, Ripoll C, Hollenbach M, Zipprich A. Stepwise diagnosis in covert hepatic encephalopathy: critical flicker frequency and MELD-score as a first-step approach. Aliment Pharmacol Ther. 2016;44(5):514–21. Epub 2016/07/08. doi: 10.1111/apt.13721 27385440.

8. Weissenborn K. Minimal/Covert Hepatic Encephalopathy—Impact of Comorbid Conditions. J Clin Exp Hepatol. 2019;9(1):109–11. Epub 2019/02/16. doi: 10.1016/j.jceh.2018.08.010 30765943; PubMed Central PMCID: PMC6363959.

9. Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study Of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014;60(2):715–35. doi: 10.1002/hep.27210 25042402.

10. Lauridsen MM, Mikkelsen S, Svensson T, Holm J, Kluver C, Gram J, et al. The continuous reaction time test for minimal hepatic encephalopathy validated by a randomized controlled multi-modal intervention-A pilot study. PLoS One. 2017;12(10):e0185412. doi: 10.1371/journal.pone.0185412 29020023

11. Lauridsen MM, Poulsen L, Rasmussen CK, Hogild M, Nielsen MK, de Muckadell OB, et al. Effects of common chronic medical conditions on psychometric tests used to diagnose minimal hepatic encephalopathy. Metab Brain Dis. 2016;31(2):267–72. doi: 10.1007/s11011-015-9741-6 26435407.

12. Lauridsen MM, Schaffalitzky de Muckadell OB, Vilstrup H. Minimal hepatic encephalopathy characterized by parallel use of the continuous reaction time and portosystemic encephalopathy tests. Metab Brain Dis. 2015;30(5):1087–92. doi: 10.1007/s11011-015-9688-7 26016624.

13. Lauridsen MM, Frojk J, de Muckadell OB, Vilstrup H. Opposite effects of sleep deprivation on the continuous reaction times in patients with liver cirrhosis and normal persons. Metab Brain Dis. 2014;29(3):655–60. doi: 10.1007/s11011-014-9583-7 25008562.

14. Lauridsen MM, Thiele M, Kimer N, Vilstrup H. The continuous reaction times method for diagnosing, grading, and monitoring minimal/covert hepatic encephalopathy. Metabolic brain disease. 2013;28(2):231–4. Epub 2013/01/10. doi: 10.1007/s11011-012-9373-z 23299303.

15. Lauridsen MM, Gronbaek H, Naeser EB, Leth ST, Vilstrup H. Gender and age effects on the continuous reaction times method in volunteers and patients with cirrhosis. Metab Brain Dis. 2012;27(4):559–65. Epub 2012/05/23. doi: 10.1007/s11011-012-9318-6 22614824.

16. Elsass P. Continuous Reaction Times in cerebral dysfunction. Acta Neurologica Scandinavica. 1986;73:225–46. doi: 10.1111/j.1600-0404.1986.tb03269.x 3521184

17. Elsass P, Christensen SE, Mortensen EL, Vilstrup H. Discrimination between organic and hepatic encephalopathy by means of continuous reaction times. Liver. 1985;5(1):29–34. Epub 1985/02/01. doi: 10.1111/j.1600-0676.1985.tb00012.x 3982241.

18. Elsass P, Christensen SE, Ranek L, Theilgaard A, Tygstrup N. Continuous reaction time in patients with hepatic encephalopathy. A quantitative measure of changes in consciousness. Scand J Gastroenterol. 1981;16(3):441–7. Epub 1981/04/01. doi: 10.3109/00365528109181995 16435490.

19. Weissenborn K. Diagnosis of minimal hepatic encephalopathy. Journal of clinical and experimental hepatology. 2015;5(Suppl 1):S54–S9. Epub 2014/07/31. doi: 10.1016/j.jceh.2014.06.005 26041959.

20. Lauridsen MM, Vilstrup H. MHE Testing in Real World Scenario. J Clin Exp Hepatol. 2018;8(4):438–40. Epub 2018/12/20. doi: 10.1016/j.jceh.2018.04.010 30564002; PubMed Central PMCID: PMC6286437.

21. Weissenborn K, Ennen JC, Schomerus H, Ruckert N, Hecker H. Neuropsychological characterization of hepatic encephalopathy. J Hepatol. 2001;34(5):768–73. Epub 2001/07/04. doi: 10.1016/s0168-8278(01)00026-5 11434627

22. Schomerus H, Weissenborn K, Hamster W, Rückert N, Hecker H. PSE-syndrom-test. Psychodiagnostisches Verfahren zur quantitativen Erfassung der (minimalen) portosystemischen Enzephalopathie Frankfurt: Swets Test Services. 1999.

23. Nabi E, Bajaj JS. Useful tests for hepatic encephalopathy in clinical practice. Curr Gastroenterol Rep. 2014;16(1):362–. doi: 10.1007/s11894-013-0362-0 24357348.

24. Hudson M, Schuchmann M. Long-term management of hepatic encephalopathy with lactulose and/or rifaximin: a review of the evidence. European journal of gastroenterology & hepatology. 2019;31(4):434–50. doi: 10.1097/MEG.0000000000001311 30444745.

25. Riggio O, Amodio P, Farcomeni A, Merli M, Nardelli S, Pasquale C, et al. A Model for Predicting Development of Overt Hepatic Encephalopathy in Patients With Cirrhosis. Clin Gastroenterol Hepatol. 2015;13(7):1346–52. doi: 10.1016/j.cgh.2014.12.025 25572976.

26. Tapper EB. Predicting Overt Hepatic Encephalopathy for the Population With Cirrhosis. Hepatology. 2019;70(1):403–9. Epub 2019/02/01. doi: 10.1002/hep.30533 30703852; PubMed Central PMCID: PMC6597301.

27. Duarte-Rojo A, Allampati S, Thacker LR, Flud CR, Patidar KR, White MB, et al. Diagnosis of covert hepatic encephalopathy: a multi-center study testing the utility of single versus combined testing. Metabolic brain disease. 2019;34(1):289–95. Epub 2018/12/07. doi: 10.1007/s11011-018-0350-z 30506333; PubMed Central PMCID: PMC6351159.

28. Ney M, Tangri N, Dobbs B, Bajaj J, Rolfson D, Ma M, et al. Predicting Hepatic Encephalopathy-Related Hospitalizations Using a Composite Assessment of Cognitive Impairment and Frailty in 355 Patients With Cirrhosis. Am J Gastroenterol. 2018;113(10):1506–15. Epub 2018/09/30. doi: 10.1038/s41395-018-0243-0 30267028.


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2019 Číslo 12