P: 63 Animal Naming Test Is Highly Accurate and Reliable for Diagnosis of Minimal Hepatic Encephalopathy in Outpatients With Cirrhosis

Abstract

BACKGROUND: Background and Aims: Minimal hepatic encephalopathy (MHE) is the mildest form in the spectrum of hepatic encephalopathy that impairs health-related quality of life. PHES remains the gold standard for the diagnosis of this condition. Animal naming test (ANT) is reliable and sensitive tool for diagnosis of MHE and can also predict overt episodes of HE. We compared usefulness of PHES and ANT for the diagnosis of MHE and for the prediction of the development of overt episodes of HE. METHODS: Between July 2017 to June 2018, one hundred and three consecutive patients with liver cirrhosis without overt HE were subjected to PHES and ANT evaluation. MHE was diagnosed when the PHES was ≤−5. Receiver-operating characteristic (ROC) curve was used to determine the optimum cut-off of ANT value for the diagnosis of MHE. The best sensitivity and specificity was found at <14. Patients were followed-up every 3-6 months till October 2018. RESULTS: Thirty-seven (35.9%) patients had MHE as assessed by altered PHES. ANT (<14) was present in 36 (34.95%) patients with MHE with sensitivity of 89.19% and specificity of 95.7%, PPV of 91.67%, NPV of 94.03% and diagnostic accuracy of 93.20%. The area under the curve for diagnosis of MHE was 0.978 (95% CI 0.954–1.0). MHE patients had significantly lower ANT as compared to non MHE patients and controls (10.81 ± 0.324 vs 15.27 ± 0.147 vs 15.78 ± 0.192, respectively, P = 0.01). MHE patients had lower hand grip strength compared to non-MHE patients and the control group (Males: 26 vs 30 vs 38, Females 25 vs 28 vs 28, P > 0.05). PHES significantly correlated with Child-Pugh (r = −0.421, P = 0.001) and model for end-stage liver disease (MELD) (r = −0.345, P = 0.001) scores. ANT correlated with PHES (r = 0.752, P = 0.001) and also with Child-Pugh (r = −0.408, P = 0.001) and MELD (r = −0.318, P = 0.001) scores. During follow-up, 14 patients in MHE group and 4 in non-MHE group developed overt episodes of HE (P = 0.001). Out of 37 patients with abnormal PHES 14 patients developed overt HE on follow up and out of 36 patients with abnormal ANT 14 patients developed overt HE on follow up. 33 patients had both PHES and ANT abnormal. 4 patients had PHES abnormal and ANT normal. 3 patients had PHES normal and ANT abnormal. CONCLUSIONS: ANT is a highly accurate and reliable test for the diagnosis of MHE and prediction of overt episodes of HE in outpatients of cirrhosis as compared to PHES and correlates well with the Child-Pugh and MELD scores.