Bajaj Jasmohan S, Saeian Kia, Schubert Christine M, Hafeezullah Muhammad, Franco Jose, Varma Rajiv R, Gibson Douglas P, Hoffmann Raymond G, Stravitz R Todd, Heuman Douglas M, Sterling Richard K, Shiffman Mitchell, Topaz Allyne, Boyett Sherry, Bell Debulon, Sanyal Arun J
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA 23221, USA.
Hepatology. 2009 Oct;50(4):1175-83. doi: 10.1002/hep.23128.
Patients with minimal hepatic encephalopathy (MHE) have impaired driving skills, but association of MHE with motor vehicle crashes is unclear. Standard psychometric tests (SPT) or inhibitory control test (ICT) can be used to diagnose MHE. The aim was to determine the association of MHE with crashes and traffic violations over the preceding year and on 1-year follow-up. Patients with cirrhosis were diagnosed with MHE by ICT (MHEICT) and SPT (MHESPT). Self and department-of-transportation (DOT)-reports were used to determine crashes and violations over the preceding year. Agreement between self and DOT-reports was analyzed. Patients then underwent 1-year follow-up for crash/violation occurrence. Crashes in those with/without MHEICT and MHESPT were compared. 167 patients with cirrhosis had DOT-reports, of which 120 also had self-reports. A significantly higher proportion of MHEICT patients with cirrhosis experienced crashes in the preceding year compared to those without MHE by self-report (17% vs 0.0%, P = 0.0004) and DOT-reports (17% vs 3%, P = 0.004, relative risk: 5.77). SPT did not differentiate between those with/without crashes. A significantly higher proportion of patients with crashes had MHEICT compared to MHESPT, both self-reported (100% vs 50%, P = 0.03) and DOT-reported (89% vs 44%, P = 0.01). There was excellent agreement between self and DOT-reports for crashes and violations (Kappa 0.90 and 0.80). 109 patients were followed prospectively. MHEICT patients had a significantly higher future crashes/violations compared to those without (22% vs 7%, P = 0.03) but MHESPT did not. MHEICT (Odds ratio: 4.51) and prior year crash/violation (Odds ratio: 2.96) were significantly associated with future crash/violation occurrence.
Patients with cirrhosis and MHEICT have a significantly higher crash rate over the preceding year and on prospective follow-up compared to patients without MHE. ICT, but not SPT performance is significantly associated with prior and future crashes and violations. There was an excellent agreement between self- and DOT-reports.
轻微肝性脑病（MHE）患者的驾驶技能受损，但MHE与机动车碰撞事故之间的关联尚不清楚。标准心理测量测试（SPT）或抑制控制测试（ICT）可用于诊断MHE。目的是确定MHE与前一年以及1年随访期内的碰撞事故和交通违规行为之间的关联。通过ICT（MHEICT）和SPT（MHESPT）诊断肝硬化患者是否患有MHE。使用自我报告和交通运输部（DOT）报告来确定前一年的碰撞事故和违规行为。分析自我报告和DOT报告之间的一致性。然后对患者进行为期1年的碰撞事故/违规行为发生情况随访。比较有/无MHEICT和MHESPT患者的碰撞事故情况。167例肝硬化患者有DOT报告，其中120例也有自我报告。自我报告显示，与无MHE的肝硬化患者相比，患有MHEICT的肝硬化患者在前一年发生碰撞事故的比例显著更高（17%对0.0%，P = 0.0004）；DOT报告显示比例也更高（17%对3%，P = 0.004，相对风险：5.77）。SPT无法区分有/无碰撞事故的患者。自我报告和DOT报告均显示，发生碰撞事故的患者中患有MHEICT的比例显著高于患有MHESPT的患者（分别为100%对50%，P = 0.03；89%对44%，P = 0.01）。自我报告和DOT报告在碰撞事故和违规行为方面具有极好的一致性（卡帕值分别为0.90和0.80）。对109例患者进行了前瞻性随访。与无MHE的患者相比，MHEICT患者未来发生碰撞事故/违规行为的比例显著更高（22%对7%，P = 0.03），但MHESPT患者则不然。MHEICT（优势比：4.51）和前一年的碰撞事故/违规行为（优势比：2.96）与未来碰撞事故/违规行为的发生显著相关。
与无MHE的患者相比，患有肝硬化和MHEICT的患者在前一年以及前瞻性随访期间的碰撞事故发生率显著更高。ICT而非SPT的表现与既往和未来的碰撞事故及违规行为显著相关。自我报告和DOT报告之间具有极好的一致性。
