The Psychometric Hepatic Encephalopathy Score for Diagnosis of Minimal Hepatic Encephalopathy in Liver Cirrhosis Patient
), I Dewa Nyoman Wibawa(2), I Gde Raka Widiana(3),
(1) Department of Internal Medicine, Faculty of Medicine of Udayana University, Udayana University Hospital, Badung, Bali, Indonesia
(2) Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine Udayana University, Denpasar, Bali, Indonesia
(3) Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine Udayana University, Denpasar, Bali, Indonesia
Corresponding Author
Abstract
Introduction: The psychometric hepatic encephalopathy score (PHES) is a tool that can be considered as a gold standard for detecting minimal hepatic encephalopathy (MHE) in liver cirrhosis patients. The PHES must be standardized based on the local healthy population before it can be used. The purpose of this study is to standardize the PHES with Indonesian local populations and set the cutoff point of PHES so it can be used to detect MHE in liver cirrhosis patients.
Methods: PHES were administered to all enrolled subjects, which are healthy subjects and cirrhosis without overt encephalopathy subjects. The PHES consists of 5 psychometric tests. The influencing factors of PHES were assessed, and equations were developed to predict the expected result of each test. Diagnosis of MHE was built upon the deviation from the normal range value of PHES.
Results: In total, 236 subjects participated in this research. The influencing factors of PHES of this study were age and education years. With the cutoff point of PHES less than -4, the prevalence of MHE was 37.7%, of which 7.6%, 50%, and 50% had Child-Turcotte-Pugh (CTP) grade A, B, and C respectively.
Conclusions: The standardized version of PHES can be used to diagnose MHE in Indonesian liver cirrhosis patients. The PHES in this study were affected by age and education years. MHE was diagnosed if the PHES was less than -4. The incidence of MHE was found to increase along with the increase of the liver disease severity
Keywords
References
Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT. Hepatic encephalopathy--definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology 2002;35(3):716-21.
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.
Bajaj JS. Minimal hepatic encephalopathy matters in daily life. World J Gastroenterol 2008;14(23):3609-15.
Wein C, Koch H, Popp B, Oehler G, Schauder P. Minimal hepatic encephalopathy impairs fitness to drive. Hepatology 2004;39(3):739-45.
Weissenborn K, Ennen JC, Schomerus H, Rückert N, Hecker H. Neuropsychological characterization of hepatic encephalopathy. J Hepatol 2001;34(5):768-73.
Weissenborn K. PHES: one label, different goods?! J Hepatol 2008;49(3):308-12.
Dhiman RK, Saraswat VA, Sharma BK, Sarin SK, Chawla YK, Butterworth R, et al; Indian National Association for Study of the Liver. Minimal hepatic encephalopathy: consensus statement of a working party of the Indian National Association for Study of the Liver. J Gastroenterol Hepatol 2010;25(6):1029-41.
Amodio P, Campagna F, Olianas S, Iannizzi P, Mapelli D, Penzo M, et al. Detection of minimal hepatic encephalopathy: normalization and optimization of the Psychometric Hepatic Encephalopathy Score. A neuropsychological and quantified EEG study. J Hepatol. 2008;49(3):346-53.
Duarte-Rojo A, Estradas J, Hernández-Ramos R, Ponce-de-León S, Córdoba J, Torre A. Validation of the psychometric hepatic encephalopathy score (PHES) for identifying patients with minimal hepatic encephalopathy. Dig Dis Sci 2011;56(10):3014-23.
Li SW, Wang K, Yu YQ, Wang HB, Li YH, Xu JM. Psychometric hepatic encephalopathy score for diagnosis of minimal hepatic encephalopathy in China. World J Gastroenterol 2013;19(46):8745-51.
Tsai CF, Chu CJ, Huang YH, Wang YP, Liu PY, Lin HC, et al. Detecting minimal hepatic encephalopathy in an endemic country for hepatitis B: the role of psychometrics and serum IL-6. PLoS One 2015;10(6):e0128437.
Seo YS, Yim SY, Jung JY, Kim CH, Kim JD, Keum B, et al. Psychometric hepatic encephalopathy score for the detection of minimal hepatic encephalopathy in Korean patients with liver cirrhosis. J Gastroenterol Hepatol 2012;27(11):1695-704.
Romero Gómez M, Córdoba J, Jover R, del Olmo J, Fernández A, Flavià M,et al; Red Nacional de Investigación en Encefalopatía Hepática. Tablas de normalidad de la población española para los tests psicométricos utilizados en el diagnóstico de la encefalopatía hepática mínima [Normality tables in the Spanish population for psychometric tests used in the diagnosis of minimal hepatic encephalopathy]. Med Clin (Barc) 2006;127(7):246-9.
Montgomery JY, Bajaj JS. Advances in the evaluation and management of minimal hepatic encephalopathy. Curr Gastroenterol Rep 2011;13(1):26-33.
Randolph C, Hilsabeck R, Kato A, Kharbanda P, Li YY, Mapelli D, et al; International Society for Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN). Neuropsychological assessment of hepatic encephalopathy: ISHEN practice guidelines. Liver Int 2009;29(5):629-35.
Romero-Gómez M, Boza F, García-Valdecasas MS, García E, Aguilar-Reina J. Subclinical hepatic encephalopathy predicts the development of overt hepatic encephalopathy. Am J Gastroenterol 2001;96(9):2718-23.
Sharma P, Sharma BC. Predictors of minimal hepatic encephalopathy in patients with cirrhosis. Saudi J Gastroenterol 2010;16(3):181-7.
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DOI: 10.24871/251202440-46
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