Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
Am J Gastroenterol. 2019 May;114(5):764-770. doi: 10.14309/ajg.0000000000000121.
Diagnosis of covert hepatic encephalopathy (CHE) is challenging and often neglected in clinical practice. The aim of this study was to develop an easy-to-perform score to predict CHE in patients with cirrhosis.
For the development or validation cohort of the proposed clinical CHE score, 142 or 96 consecutive patients with cirrhosis were prospectively enrolled. The Psychometric Hepatic Encephalopathy Score was used to detect minimal hepatic encephalopathy. All patients were examined with the simplified animal naming test and were asked to complete the Chronic Liver Disease Questionnaire. We followed the TRIPOD guideline for development, validation, and reporting of the proposed score.
The clinical covert hepatic encephalopathy score containing the variables-clinically detectable ascites, history of overt hepatic encephalopathy (OHE), albumin serum level, activity subdomain of the Chronic Liver Disease Questionnaire, and simplified animal naming test-discriminated best between patients with and without CHE. We generated 2 cutoff values for the identification of the high-, intermediate- (with need for additional specialized testing), and low-risk groups for CHE. By applying these cutoffs, the sensitivity, specificity, positive predictive value, and negative predictive value were 90%, 91%, 85%, and 94%, respectively. The AUC was 0.908 or 0.872 for the development or the validation cohort, respectively. Higher scores were further associated with poorer quality of life, and the high-risk group was predictive for first-time OHE within 180 days.
We developed an easy-to-perform score to identify patients with cirrhosis at risk of CHE, which correlates with quality of life and risk of first-time OHE.
隐匿性肝性脑病（CHE）的诊断具有挑战性，在临床实践中常被忽视。本研究旨在开发一种易于实施的评分系统，以预测肝硬化患者的 CHE。
在提出的临床 CHE 评分的开发或验证队列中，前瞻性纳入了 142 或 96 例连续肝硬化患者。使用心理计量肝脏脑病评分检测轻微肝性脑病。所有患者均接受简化动物命名测试检查，并完成慢性肝病问卷。我们遵循 TRIPOD 指南制定、验证和报告所提出的评分。
包含临床可检测腹水、显性肝性脑病（OHE）史、白蛋白血清水平、慢性肝病问卷的活动子域以及简化动物命名测试等变量的临床隐匿性肝性脑病评分，可最佳区分有和无 CHE 的患者。我们生成了两个临界值，以识别 CHE 高风险、中风险（需要额外的专门检测）和低风险组。应用这些临界值，敏感性、特异性、阳性预测值和阴性预测值分别为 90%、91%、85%和 94%。AUC 分别为 0.908 或 0.872，用于开发或验证队列。更高的分数与生活质量更差相关，高风险组可预测 180 天内首次出现 OHE。
我们开发了一种易于实施的评分系统，以识别有 CHE 风险的肝硬化患者，该评分与生活质量和首次发生 OHE 的风险相关。
